VA MISSION Act launch: Here’s how to use your new urgent care benefit

Abbie Bennett
June 03, 2019 - 9:43 am
UrgentCare

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The MISSION Act launches June 6 and means greater access and flexibility for veterans in choosing their healthcare providers. One of those changes covers urgent care.

Rather than go to a VA facility’s emergency room or another alternative, the MISSION Act allows veterans to go to civilian urgent care clinics.

The MISSION Act, signed into law by President Donald Trump last year, replaces the expiring CHOICE Act and allows veterans who meet certain criteria (such as long wait times, specialty care needs and more) to see private doctors while the VA picks up the bill. But a continual issue has been emergency care -- or, rather, the need to see a doctor right away, but not necessarily requiring a trauma response from an ER.

Under the MISSION Act activating June 6, veterans will be able to go to urgent care facilities, with some caveats.

  • The urgent care provider must be part of the VA’s contracted network of community healthcare providers or the veteran may have to pay the full cost of care.
  • VA won’t pay your urgent care bill if you go for preventative care or dental services. The urgent care benefit is not intended to replace a normal doctor.
  • You must be enrolled in VA healthcare and received care through the VA within 24 months to be eligible for the urgent care benefit.
  • Only eligible veterans can use the benefit. Family members cannot use it.
  • You may be charged a copayment for your urgent care visit, based on how many times you’ve gone to urgent care and what your assigned veteran priority group is. Some may pay nothing for the first three visits, then $30 per visit to urgent care for the fourth and subsequent visit in a single calendar year. Others will pay $30 per visit regardless of number of visits. Flu shots at urgent care will never require a copay.
  • There is no limit on the number of times an eligible veteran can access urgent care.
  • Copayments are not paid by the veteran out-of-pocket. The VA will bill you separately.
  • VA also will pay for or fill prescriptions from urgent care, but if the medication is longer than a 14-day supply, the prescription must be submitted and filled by the VA. Some veterans may be required to pay a copay for medication.

The VA MISSION Act launches June 6: Here's who's eligible to see private doctors

When urgent care benefits start, veterans can contact the VA Health Resource Center for questions about copayments at 1-877-222-VETS. Veterans should also contact their local VA medical facility for more information about accessing urgent care.

To find an available urgent care provider in the VA’s network, go to www.va.gov/find-locations.

When you arrive at urgent care:

  • Check to make sure the urgent care provider is in the VA network.
  • Let the urgent care staff know you want to use your VA urgent care benefit.
  • The urgent care provider will confirm your veteran eligibility before providing care.

What does the urgent care benefit cover?

  • Non-emergency symptoms such as flu-like symptoms, cough, colds, wheezing, sprains, sore throats, painful urination, ear pain, skin irritations, bumps and bruises, pink eye and more.
  • X-rays, some lab testing, some vaccines and some medications.
  • Veterans concerned about the complexities of their medical history or medications should seek treatment from their primary care doctor instead of urgent care.
  • Medical emergencies should always be treated at the nearest emergency room.
  • If a veteran goes to urgent care and receives services not covered by the benefit, they may be required to pay the full cost.

After your urgent care visit:

  • The urgent care provider must file a claim and the claim must be paid by VA.
  • Follow-up medical documentation must be sent to the veteran’s home VAS medical facility.

For more information on the MISSION Act, go to www.missionact.va.gov.

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