How long should you wait for a PCP appointment at the VA or non-VA care provider?

30 days

????????  There are about 40 different types of VA appointments based on the purpose of the visit. The over 30-day rule seems to apply to primary care appointments.  Follow-ups are determined differently.

Secretary McDonald said this in a recent speech to the DAV:

We are making good progress in getting Veterans off wait lists and fixing scheduling problems.  We have reached out to over 240,000 Veterans to get them off wait lists and into clinics sooner.  In just the last two months, we have made over 791,000 referrals for Veterans to receive their care in the private sector—that’s up more than 164,000 over the same time last year.     Each one of these referrals, on average, results in 7 visits or appointments.    So, we’re talking about 1.1 million additional appointments in the private sector just from increased referrals over the last two months. 

Can you request a non-VA care referral if the wait is over 30 days?  Looks like a yes. Or you can opt for the wait list–the real one called the Electronic Waiting List (EWL).  

va wait lists

Secret VA  wait lists of the recent past…

But are you eligible for non-VA care?  The VA says it’s “complicated” and vets will be prioritized. If eligible, they’ll get a three-way conference call or if they can’t reach you, they’ll send you a letter, authorization code, appointment time and location. The provider cannot charge vets any co-pays, deductibles or fees–even if the vet is a no-show. 

From a June 2014 Fact Sheet

VA has accelerated care for Veterans currently waiting for health care services. VHA is in the process of contacting in excess of 90,000 Veterans during the first phase of VA’s “Accelerating Access to Care Initiative” VHA will provide Veterans who do not currently have an appointment, or are waiting for additional care or services longer than 30 days the option to be rescheduled sooner if VA capacity exists, keep their scheduled appointment, or be referred to non-VA providers in the community.

I’m hopeful that these changes we’re beginning to learn about will be lifesaving and quality-of-life improving for many.

About Laura

NW Vermont.
This entry was posted in Guest authors, Medical News, Medicare for VETS, VA Health Care, VA Medical Mysteries Explained and tagged , , , , , , , , , , , , , , , , . Bookmark the permalink.

4 Responses to How long should you wait for a PCP appointment at the VA or non-VA care provider?

  1. david j murphy says:

    I think that’s about everybody. I don’t know a vet who gets a appt in less than 30 days. You call for PC and they tell me they are “allready booked this month, can we schedule you for next month. If you belive the tooth fairy, San Antonio VA is ahead of the game as far as the rest of the country.

    • Kiedove says:

      Then tell them their new boss, Sec. McDonald, says to see if I’m eligible to see a private contracted PCP, and get back to me immediately! Their goal is supposed to be 14 days standard but that is a long way off.
      My hubby was sick last year, was told he could see his VA doc. in a month, so he went to a local Mayo doc. His VA doc told him later to tell the call center to make an acute appointment. He said he always leaves some slots every day for someone who needs to be seen right away. He was actually upset about this. So ask your VA doc if he/she has acute apt. slots and then you can make a stink when you call to see them.

      • SquidlyOne says:

        It’s up to the private health care provider if they want to accept VA patients at the medicare rate. The time limit on the new law is 2 years and then it expires. There aren’t ANY health care providers In my state that will sign for that. If you mention the VA they get all disgusted because the VA balks at payment most of the time. They can’t run a business like that. Vets already take a ding on their credit and get sued because the VA refuses to pay for emergency care when legally they are bound to. My part A medicare card is worthless in my state. Waiting 4 years for a BVA hearing to get re-reimbursed is ridiculous!

        On the positive side I get in to see my PCP when I need to and since they are a CBOC they can contract private specialists at the whim of my PCP. As far as the parent VAMC two hours away…probably better off calling the morgue.

        • Kiedove says:

          I think any providers who sign up with Tri-West will get paid by Tri-West within 30 days. They are administering the VA funds. The private providers billing dept. can get trained online or with Tri-West. Frankly, any doctor who takes Medicare but won’t participate in the PCCC program should be called out as slime. Tri-West has a five-year contract which is better. I’m optimistic that if the private docs have filled out their claims with the right medical codes etc..they will get paid be paid as fast as private insurers pay. Some of them are horrible. There may be changes underway with streamlining the emergency room billing. After all, they take Medicare. The do have to call the nearest VMAC when a vet comes in and get instructions. Depending on what’s wrong, the vet can be treated there, taken by ambulance to the local VAMC if the can deal with the type of emergency, or be taken by ambulance to the nearest facility that can treat the vet. I’m thinking special facilities that have a burn unit.
          For the CBOCs, I do agree that a two year contract is way too short. If say a small regional hospital contracts with the VA, they could get set up, then two years later a cheaper provider wins the VA contract. Vets have to change venue. Not good care. The hospital has the expense of dismantling the VA clinic. What’s missing here is the input by veterans and the local communities. The patients have no voice except through service organizations (maybe) or elected representatives (maybe). If vets like their CBOCs they should be able to keep them. Docs already in practice have little to risk in the PCCC scheme because they are already set up for business and they’ll be paid faster by organizations like Tri-West.
          But please, keep letting us know what you are seeing and hearing in your community!

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