Ah, the VA hospital. The place that no one gets excited to go to. Appointments are hard to schedule. When you finally arrive for your appointment, it still takes forever. To top it all off, the doctors often don’t listen. So how do Veterans get around that? Cue Community Care.
A Brief Lesson
In 2014 President Obama signed a bill called the Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014. This was signed after more acts of misconduct within VA hospitals were brought to light. The bill allows Veterans to seek care at their own medical clinics while still using VA health insurance. This is important if you live in a rural area, having doctors that you already love, or have had just a miserable time with your local VA hospital.
“This is particularly important for veterans who are in more remote areas and rural areas,” Obama said. Essentially, this allows veterans living more than 40 miles from a VA facility, or those for whom a VA doctor is not available, to use health care providers outside the VA system.”-Defense.gov
Many Veterans think that getting approved to do this is a complicated and lengthy process but honestly it really isn’t. This article is going to be about my personal experience with getting approved to use community care through the VA, using it, and information about how you should go about it best. I promise, this is a simple process and can change your life.
The process to be approved and use VA health insurance at your private clinic is simple but can be confusing in the beginning. Just ensure that everything is done pretty quickly and that after a referral is made by your doctor you don’t wait to get the authorization form as that referral expires in 14 days.
The Process
- Get established with the VA. An appointment isn’t needed but getting established as in getting an ID card and having their health insurance is the first step. If you already have VA healthcare meaning you get a form in the mail every year during tax season showing that you are covered under VA health insurance then from that point you will just need an ID card. This can be done online. They literally mail it to you.
- Make an appointment to establish care with the VA. You will first need to call the VA. Be patient as they may push you to the large VA system or your local hospital. First appointments can be the longest wait to book so be sure to get this appointment on the books asap. The only way to get approved for community care is to first see a VA doctor that will refer you for it.
- Go to the appointment and request community care. Tell them everything including your specific doctors and clinics that you normally use. In my case, I chose to make my primary care and women’s health stay within the VA because I really liked the outpatient clinic that they sent me to. However, I did ask to have community care for my Gastroenterologist and my Dermatologist, both different clinics and doctors. The VA doctor will then ask the specific clinic and doctor and if you have an appointment already. This is important. It’s good to already have established care with the clinic that you want to go to for community care, this includes having an appointment on the books with them. If you don’t have an appointment on the books for your private clinic the VA will have to make one themselves and that just lengthens the process. Also, if you don’t already have a specific clinic that you like, the VA will have to find one themselves, also lengthening the process.
Note: The community care clinic that you want to use VA health insurance for needs to be in network with the VA meaning that they accept Optum pay, the pay that the VA uses. If your clinic does not accept VA health insurance the VA will need to find you another clinic.
4. During your visit at the VA The doctor puts in the referral to the VA for you to use community care at those clinics.
5. The VA calls you, YOU HAVE TO PICK UP. The referral will no longer be valid if you don’t call the VA community care line back. With this they either schedule a consult or send an authorization form to your community care clinic. Scheduling a consult simply means that they will call your personal clinic and schedule an appointment if you have never been there before. If you already have an appointment on the books, this step can be skipped.
6. One week before going to your appointment at your personal clinic Call your clinic to ensure that they have received the authorization form. If they haven’t, you cannot use VA healthcare for that appointment. You yourself will receive an authorization form in the mail as well. Keep this form.
Medications
When it comes to medications and community care often the question comes up of, okay so who prescribes me meds now, the private doctor or my VA still? Well, both. Your community care clinic can still prescribe you medications however those prescriptions do need to be filled at a VA pharmacy. To get this done the community care clinic will simply need to fax the prescriptions to the VA pharmacy. Your medications will then be mailed to you.
The clinic should know how to do this if they are in the network and have taken care of Veterans with VA health insurance before however it doesn’t hurt to get the proper fax number for the VA pharmacy to give to your private clinic just in case.
This is a great map to show you what payment method is being used in your area to pay for your community care. When asking if your private clinic is in-network for the VA this is an easier way to ask. Just ask if they take Optum or TriWest dependent on your location. Photo: VA.gov
Important Things to Remember
-Bring the authorization form to your appointment at your community care clinic each time to ensure that nothing gets missed and you aren’t stuck with the bill.
-The Authorization letter expires every 6 months. You have to call and have your doctor write you a new authorization before you current one expires or you will have to get the bill for your appointment. The doctor will not remind you of this it is up to you and there is no way around it.
-Sometimes the VA won’t approve community care. It sucks, but it’s true. If you are looking to use community care for routine annual physicals and are within the 50 miles of a VA hospital, they probably won’t approve it. However if you are with a specialty doctor and get specialty medication that the VA doesn’t usually provide or isn’t within 50 miles, it most likely will get approved. Sometimes even just the VA doctor may have it out for you and not grant it. If that’s the case, keep trying with other doctors and reasoning as to why you need community care.
-The VA may not pay for your entire visit and medication. This can differ dependent on your disability rating and service connection. This is an important question to ask your doctor if you have a lower disability rating.
What To Still Fight For
While all of this is a HUGE step in the right direction for Veterans and their health there are still some things that do need to be worked and can be fought for with your local officials and presidential administration. One, the fact that some Veterans are ineligible for community care is ridiculous. A Veteran can’t continue to see the doctor that they may have been seeing for years under VA health insurance due to driving time or other arbitrary reasons should not be the case.
Two, that authorization forms expire. Many of the conditions that Veterans are being approved for are lifelong conditions, why should the authorization for community care expire in 6 months? Not to mention, if that Veteran forgets to renew it, they are stuck with the bill. It’s not right.
It’s important not to stop fighting for more freedom when it comes to using VA healthcare. With VA disability money in current talks of being lowered, we need to make good decisions in how we vote.
For more information click here and here or call your VA and follow the prompts for the community care team. You can also ask your VA health doctor at your next appointment as this needs to happen anyways in order to be authorized for community care.
Some of what you state is correct and some info is not correct. I have been in the system as service connected. And there is a lot the Optum doess not pay and when they do it is so dam less it is a wonger the Dr. will work with the VA.