Urgent Care Quick Start Guide

Accessing
Urgent Care
This guide will help you understand how to access urgent care services from
a provider in VA’s contracted network. The urgent care benefit provides
eligible Veterans with greater choices and access to timely, high-quality care.
What is the urgent care benefit? HOW DO I CONFIRM

VA offers eligible Veterans an urgent care benefit for the treatment of minor I AM ELIGIBLE?
injuries and illnesses at retail and urgent care providers who are part of VA’s To check eligibility, call VA411 at 800-
698-2411 or contact your local medical
contracted network. The urgent care benefit is offered to Veterans in
facility.
addition to urgent care and same-day services VA provides through its
medical facilities.
HOW CAN I CONFIRM THAT
THE PROVIDER IS IN VA’S
What type of care do urgent care providers provide? NETWORK?
Urgent care providers treat injuries and illnesses that require immediate You can determine if a provider is
in-network by using the VA’s facility
attention but are not life-threatening, such as the common cold, minor burns locator at at https://www.va.gov/find-
and skin infections. locations. For telephone assistance
finding locations, please call 877-881-
7618 (8 a.m. – 8 p.m. ET).
Am I eligible for urgent care?
To be eligible for the urgent care benefit, you must (1) be enrolled in the VA WHAT ELSE DO I NEED
healthcare system, AND (2) have received care through VA, from either a VA or TO KNOW?
a community provider within the last 24 months. If you believe your life or health is in
danger, call 911 or go to the nearest
emergency department right away.
How do I access urgent care? You do NOT have an insurance card for
this benefit.
Use VA’s Facility Locator at https://www.va.gov/find-locations. To find an urgent
Do NOT pay a copayment at the time
care location, select the “Urgent care” VA facility type and then “Community of visit—if you are eligible for this
urgent care providers (in VA’s network)” from the service type drop-down. You can benefit. VA will bill you separately for
also call your local VA medical facility to find an in-network urgent care provider. any applicable copayment.
What do I do when I arrive?

Tell the urgent care provider you would like to use your VA urgent care benefit
and confirm that they are part of VA’s network. They will confirm your eligibility
for the benefit. If there is an issue verifying your eligibility or if you have any
other issue at an urgent care location in AK, AS, AZ, CA, CO, GU, HI, ID, MP, MT, NM,
NV, OR, TX, UT, WA, and WY call 866-620-2071. In DC, PR, VI, and all other states,
call 888-901-6609.
CONTACT US VISIT US ONLINE VA.gov/communitycare VISIT US IN PERSON at your local VA Medical Center
OTHER QUESTIONS YOU MAY HAVE ADDITIONAL INFORMATION
Will I have to pay any fees or copayments out-of-pocket?
You may be charged a copayment that is different from other VA medical copayments. What services are covered?
Copayments depend on your assigned priority group and the number of times you visit Find a list of services at:
an urgent care provider in a calendar year. https://www.va.gov/COMMUNITYCARE/
programs/veterans/Urgent_Care
Priority Group Copayment Amount (per calendar year)
How do I find an in-network
• First three (3) visits: $0
1–5 pharmacy?
• Fourth and > visits: $30 Visit Va’s facility locator at https://www.
• If related to combat experience, va.gov/find-locations to locate.
6
*special authority or exposure:
 First three (3) visits: $0
How do I find a VA medical facility?
Use VA’s facility locator at https://www.
 Fourth and > visits: $30
va.gov/find-locations
• If not related to combat experience, special
authority or exposure:
Does VA reimburse beneficiary
 $30 per visit
travel for an urgent care visit?
7–8 • $30 per visit VA reimburses beneficiary travel for
eligible Veterans that must travel to receive
1–8 • $0 copay for a visit consisting of only a flu shot community care. Payment is made for the
distance to either the nearest VA medical
facility or community medical facility that
There is no limit on the number of times you can access urgent care. could have provided the care or services.
Copayments are NOT paid out-of-pocket at the time you receive care. They are billed
separately by VA. What are special authorities?
*Special authorities include those related
to combat service and exposures (e.g. Agent
Can I use urgent care as a replacement for my primary care needs? Orange, active duty at Camp LeJeune,
No. Urgent care is not a replacement for preventive health care or management Ionizing radiation, Project Shipboard Hazard
of chronic or complex health conditions. You should work with your primary care and Defense (SHAD/ Project 112), Southwest
provider for this type of care. If you go to an urgent care provider and receive non Asian Conditions) as well as Military Sexual
covered services, you are responsible for the full cost of care. Trauma, and presumptions applicable to
certain Veterans with psychosis and other
mental illnesses.
Is urgent care prescription medication covered by VA?
VA will pay for or fill prescriptions resulting from your urgent care visit.
Urgent care prescriptions for medication longer than a 14-day supply must be sent to
VA to be filled.
You can fill a 14-day supply of medication written by an urgent care provider at a
contracted pharmacy within the VA network, a non-contracted pharmacy that is not
part of the VA network, or directly at a VA pharmacy. Opiates will be limited to seven
days or less, consistent with the pharmacy location’s state law.
If a non-contracted pharmacy is used, you must pay for the prescription and then file
a claim for reimbursement with your local VA medical facility.
Do I have to pay a copayment for urgent care prescription

medication?
You may be required to pay a copayment for medication. These will be billed
separately to you, by VA, as a part of VA’s normal billing process.
Last updated: 10/01/2020

Urgent Care Quick Start Guide

Uploaded by

Copyright:

Available Formats

Urgent Care Quick Start Guide

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Urgent Care Quick Start Guide

Uploaded by

Copyright:

Available Formats

Accessing

What is the urgent care benefit? HOW DO I CONFIRM

What do I do when I arrive?

Do I have to pay a copayment for urgent care prescription

Last updated: 10/01/2020

You might also like