Accessing Urgent CareThis guide will help you understand how to a es - PDF document

1 Accessing Urgent CareThis guide will he
Accessing Urgent CareThis guide will help you understand how to a ess urgent are servi es from a provider in VA’s ontra ted network. The urgent are bene�t provides eligible Veterans with greater hoi es and a ess to timely, high-quality are. What is the urgent care benefit?VA o�ers eligible Veterans an urgent are bene�t for the treatment of minor injuries and illnesses at retail and urgent are providers who are part of VA’s ontra ted network. The urgent care benefit is oered to Veterans in addition to urgent care and same-day services VA provides through its medical facilities.What type of care do urgent care providers provide?Urgent are providers treat injuries and illnesses that require immediate attention but are not life-threatening, su h as the ommon old, minor burns and skin infe tions.Am I eligible for urgent care?To be eligible for the urgent are bene�t, you must (1) be enrolled in the VA health are system, AND (2) have re eived are through VA, from either a VA or a ommunity provider within the last 24 months.How do I access urgent care?Use VA’s Fa ility Lo ator at https://www.va.gov/�nd-lo ations. To �nd an urgent are lo ation, sele t the “Urgent are” VA fa ility type and then “Community urgent are providers (in VA’s network)” from the servi e type drop-down. You an also all your lo al VA medi al fa ility to �nd an in-network urgent are provider.What do I do when I arrive?Tell the urgent are provider you would like to use your VA urgent are bene�t and on�rm that they are part of VA’s network. They will on�rm your eligibility for the bene�t. If there is an issue verifying your eligibility or if you have any other issue at an urgent are lo ation in AK, AS, AZ, CA, CO, GU, HI, ID, MP, MT, NM, NV, OR, TX, UT, WA, and WY all . In DC, PR, VI, and all other states, call HOW DO I CONFIRM To check eligibility, call VA411 at 800-698-2411 or contact your local medical facility.HOW CAN I CONFIRM THAT THE PROVIDER IS IN VA’S NETWORK?You can determine if a provider is in-network by using the VA’s facility locator at at https://www.va.gov/�nd-locations. For telephone assistance �nding lo ations, please call 7618 (8 a.m. – 8 p.m. ET).WHAT ELSE DO I NEED TO KNOW?If you believe your life or health is in danger, call 911 or go to the nearest emergency department right away.You do NOT have an insurance card for this bene�t.NOT pay a copayment at the time of visit—if you are eligible for this bene�t. VA will bill you separately for any applicable copayment.CONTACT US VISIT US ONLINE VA.gov/communitycare VISIT US IN PERSON at your local VA Medical Center OTHER QUESTIONS YOU MAY HAVE Will I have to pay any fees or copayments out-of-pocket?You may be harged a opayment that is di�erent from other VA medi al opayments. Copa

2 yments depend on your assigned priority
yments depend on your assigned priority group and the number of times you visit an urgent are provider in a alendar year. Priority GroupCopayment Amount (per calendar year)• First three (3) visits: $0• Fourth and > visits: $30If related to combat experience, *special authority or exposure: First three (3) visits: $0 Fourth and > visits: $30If not related to combat experience, special authority or exposure:$0 opay for a visit onsisting of only a �u shot There is no limit on the number of times you an a ess urgent are.Copayments are NOT paid out-of-po ket at the time you re eive are. They are billed separately by VA.Can I use urgent care as a replacement for my primary care needs?No. Urgent are is not a repla ement for preventive health are or management of hroni or omplex health onditions. You should work with your primary are provider for this type of are. If you go to an urgent care provider and receive non covered services, you are responsible for the full cost of care.Is urgent care prescription medication covered by VA?VA will pay for or �ll pres riptions resulting from your urgent are visit. Urgent are pres riptions for medi ation longer than a 14-day supply must be sent to VA to be �lled.You an �ll a 14-day supply of medi ation written by an urgent are provider at a ontra ted pharma y within the VA network, a non- ontra ted pharma y that is not part of the VA network, or dire tly at a VA pharma y. Opiates will be limited to seven days or less, onsistent with the pharma y lo ation’s state law.If a non- ontra ted pharma y is used, you must pay for the pres ription and then �le a laim for reimbursement with your lo al VA medi al fa ility.Do I have to pay a copayment for urgent care prescription medication?You may be required to pay a opayment for medi ation. These will be billed separately to you, by VA, as a part of VA’s normal billing pro ess. ADDITIONAL INFORMATIONWhat services are covered?Find a list of servi es at: https://www.va.gov/COMMUNITYCARE/programs/veterans/Urgent_CareHow do I find an in-network Visit Va’s fa ility lo ator athttps://www.va.gov/�nd-lo ations to locate.How do I find a VA medical facility?Use VA’s fa ility lo ator at https://www.va.gov/�nd-lo ationsDoes VA reimburse beneficiary travel for an urgent care visit?VA reimburses bene� iary travel for eligible Veterans that must travel to re eive ommunity are. Payment is made for the distan e to either the nearest VA medi al fa ility or ommunity medi al fa ility that ould have provided the are or servi es.What are special authorities? in lude those related to ombat servi e and exposures (e.g. Agent Orange, a tive duty at Camp LeJeune, Ionizing radiation, Proje t Shipboard Hazard and Defense (SHAD/ Proje t 112), Southwest Asian Conditions) as well as Military Sexual Trauma, and presumptions appli able to ertain Veterans with psy hosis and other mental illnesses.Last updated: 10/01/202