Community Care

I’m not going to be able to cover everything there is to cover about community care, but I do want to talk about some of the basics that you should be aware of. And just to make sure we’re all on the same page, when I say community care, I’m talking about medical care, paid for by the VA, but not at a VA hospital or clinic.

First of all, always get community care approved by the VA first, unless it is a medical emergency, or it’s an urgent care type situation. I’ll get into both of those in a minute. If you are dealing with a chronic medical problem or if it’s a new problem that’s just popped up but it’s not immediately life-threatening, you have no excuse. Contact the VA, get it approved ahead of time, and get proof of that approval. The VA will typically mail you a letter with confirmation, but you can also find it online. Log on to VA.gov, follow the links to your medical records, get to your ‘VA Blue Button Report’ it should be in there. I know, I can find my community care referrals in there but sometimes it might take a few days for the referral to show up in the records. I’ve made a video on how to access your VA medical records, which you should be able to find here.

If you go somewhere for medical care without prior approval, don’t kid yourself, you’re taking a big risk. Ask yourself, can I pay for this visit or treatment or whatever out of my own pocket. If the answer is no, and it’s not a medical emergency, please consider waiting on that approval.

Ok, so what about medical emergencies? If you are receiving VA health care for a service-connected disability or you’ve been seen by the VA in the last two years, the VA will pay for emergency medical care as long as your medical situation is such that a prudent layperson would reasonably expect that a delay in seeking immediate medical attention would be hazardous to life or health. Also, expect that the VA will try to move you to a VA hospital when you are stable. If you refuse that transfer, the VA will no longer pay. Also, note that it is very important that you contact the VA within 72 hours to let them know you are in or went to the emergency room. This part is important although it may not be a deal-breaker as far as the VA paying, so think about who are the people that are going to show up when you are in the ER and make sure they know that the VA needs to be notified.

With urgent care, there are two big things to be aware of. First, you have to make sure that you have been seen by your VA primary care team at some point within the past 2 years. So just make sure you get your annual checkup from the VA, and you’re good with that. Second, you have to make sure the urgent care provider is approved by the VA. Use this link to the VA’s website where you can search for approved urgent care providers in your area. This is a good thing to know before you’re in a situation where you need to go to urgent care. I’ve used this program personally, and have had no problems with it. So it is possible. And if you are in doubt, go ahead and call the VA first and ask them if it’s ok for you to go to urgent care for whatever you’ve got going on.

For any of this treatment, remember that depending on your situation with the VA, the VA may charge you a co-pay. If they do, the VA will bill you for that separately. I should add again that, if you haven’t been to a VA hospital or clinic in the last two years for some type of medical treatment, don’t expect the VA to pay for your community care.

There’s so much more that could be said about this topic, this only covers the basics. Even though this wasn’t about a disability issue, if you’d like me to help you with your VA disability claims, you can reach out to me through the links on this page.