Community Care: Emergency and Urgent Care
Overview
VA Community Care allows eligible veterans to receive care from non-VA providers when VA facilities cannot provide timely or accessible care. This includes urgent care and emergency services.
Pro Tip: Can't get a timely VA appointment? Community Care lets you see civilian providers on the VA's dime. Know the eligibility rules—if the VA can't see you within their own standards, they have to send you out.
Urgent Care
Urgent care addresses minor injuries and illnesses that are not life-threatening, including: - Colds and flu - Strep throat - Muscle sprains - Skin infections - Ear infections - Minor cuts requiring stitches
Key Note: You do NOT need to inform the VA when you use urgent care facilities.
Eligibility Requirements
Veterans must meet all three criteria: - Maintain enrollment in VA Healthcare - Visit an in-network urgent care provider - Have received VA or Community Care services within the past 2 years
Finding Urgent Care Providers
- Use the VA Facility Locator at va.gov/find-locations
- Contact your local VA medical facility
- Call 877-881-7618
Accessing Urgent Care
- Inform the provider you wish to use your VA urgent care benefit
- Ask and verify the provider is part of the VA contracted network
- Look for posted signage indicating network participation
Important: Do not pay copayments at the time of service.
Provider Network Issues
For disputes, contact regional administrators: - Regions 1-3 (Eastern/Midwest states): 888-901-6609 - Regions 4-6 (Western/Pacific states): 866-620-2071
Medications from Urgent Care
- VA covers a 14-day supply with no refills from in-network providers
- Prescriptions may be filled at:
- In-network pharmacies
- VA facilities
- Non-network pharmacies (requires patient reimbursement)
- Prescriptions must be filled in the same state as the visit
- Opioids limited to seven days or fewer
- Supplies exceeding 14 days require VA processing
Urgent Care Copays by Priority Group
| Priority Group | Visits 1-3 | Visits 4+ |
|---|---|---|
| 1-5 | FREE | Copay required |
| 6 | FREE* | Copay required |
| 7-8 | Copay required | Copay required |
*Free for conditions related to: - Agent Orange exposure - Camp Lejeune exposure - Ionizing radiation - Project SHAD/112 - Southwest Asia conditions - Military sexual trauma - Certain mental health conditions
Medication Copays
Veterans never owe copays for medication related to service-connected disabilities!
| Priority Group | Copay Status |
|---|---|
| 1, 4 | FREE |
| 2, 3, 5, 6, 7, 8 | Copay required |
Emergency Care
What Constitutes an Emergency
Life-threatening conditions requiring immediate treatment: - Chest pain or heart attack symptoms - Difficulty breathing - Severe bleeding - Loss of consciousness - Stroke symptoms - Severe injuries
Emergency Care Coverage
The VA may pay for emergency care at non-VA facilities if: - Delay would endanger life or health - VA facility not feasibly available - Treatment was for a service-connected condition, OR - Veteran is enrolled in VA healthcare
What to Do in an Emergency
- Call 911 or go to nearest emergency room
- Receive stabilizing treatment
- Notify VA within 72 hours of admission
- Request transfer to VA facility when stable (if appropriate)
Emergency Care Notification
Contact VA within 72 hours at: - Your local VA medical center - 844-724-7842
Coverage Limitations
- VA covers until veteran can be safely transferred
- Non-service-connected emergencies may have limitations
- Prior authorization not required for true emergencies
Mission Act Eligibility
Under the MISSION Act, veterans may qualify for community care if: - VA cannot provide care within designated wait times - VA cannot provide care within designated drive times - Veteran and VA agree community care is in veteran's best interest - Veteran needs a service not available at VA
Access Standards
Wait Time: - Primary care: 20 days - Mental health: 20 days - Specialty care: 28 days
Drive Time: - Primary care: 30 minutes - Mental health: 30 minutes - Specialty care: 60 minutes
Filing for Reimbursement
If you paid out-of-pocket for emergency care: - File VA Form 10-583 for reimbursement - Include itemized bills and proof of payment - Submit within 2 years of care date