When not to “Take the Pain”–New Urgent Care benefit for VA enrollees


Shut up! It’s Sunday!

Bill jargon.  Yawn. But stay with me for a little while because the Urgent Care* benefit is worth knowing about– especially for veterans who only have VA health care.

VA > Health Care > Community Care > Urgent Care: LINK.

The old VA Patient’s Choice cards program are toast now that the Mission Act of 2018 (S. 2372) is enacted but gotcha’s still exist. (Gotcha is VA’s middle name.)  An ominous  “Scope of Care”example from Federal Register Final Rule:

VA will not provide an exhaustive list to account for the needed flexibility in administering the benefit. VA will monitor utilization of this benefit and may make further revisions to the website in the future. Any services provided that are outside of the scope of this benefit are the financial liability of the veteran.

But, but…the scope of care is not defined for patients and providers. And where are the promised educational Sec. 120 materials?  

Page 6, Mission Act LINK

‘‘(2) The Secretary may limit the types of hospital care, medical services, or extended care services covered veterans
may receive under paragraph (1) in terms of the length of time such care and services will be available, the location
at which such care and services will be available, and the
clinical care and services that will be available.

Congress says, ‘‘§ 1725A. Access to walk-in care  (Sec. 105, page 20-21)  “The Secretary shall develop procedures to ensure that eligible veterans
are able to access walk-in care from qualifying non-Department
entities or providers.”

This commandment makes sense but limits local providers because most are not connected to VA virtually and rely on fax machines.  Therefore a “continuity of care” method may not qualify as a suitable “…establishment of a mechanism to receive medical records from walk-in care providers and provide pertinent patient medical records to providers of walk-in care.”
Result? A puny list of network providers.

The Secretary may enter into contracts and set copayments.
‘‘(h) WALK-IN CARE DEFINED.—”…means non-emergent care provided by a qualifying non Department entity or provider that furnishes episodic care and not longitudinal management of conditions….”

The VA Urgent website gives a very short list of covered services, much shorter than services often available. Vets and non-VA regional hospitals have been burnt badly by promised but unpaid non-VA emergency room visits. Will this negative history repeat itself with this “high value” health program?  Some locations, like Walgreens, can give free flu shots, but don’t even think about getting any free routine preventative services at urgent care even if they could be combined with an urgent care treatment at a low cost to VA!

Are you eligible for zero ($) copays or $30 copay visits and RX (14 days max)? This depends on your Priority Group and VA-enrollment status within the last 24 months.  Caveats–unknown issues:  Service-connection copays?  How does other health insurance influence payments? 

Overview (again) page with video: https://www.va.gov/COMMUNITYCARE/programs/veterans/Urgent_Care.asp#Medication

To find contracted Urgent Care use Tricare’s imperfect locator (Call before going):

Step 1. Read the locator warning page:  https://vaurgentcarelocator.triwest.com/

Step. 2 Scroll down and Pick

VA Urgent Care and Retail Locations

https://vaurgentcarelocator.triwest.com/Locator/Care

or VA Urgent Care Pharmacy Locations

https://vaurgentcarelocator.triwest.com/Locator/RX

To see inside the rule-makers tricky minds–check out the Final Urgent Care rule. Also, it’s interesting to read the commenters thoughts about copayments and VA’s responses.

https://www.federalregister.gov/documents/2019/06/05/2019-11468/urgent-care

*  “VA refers to this benefit as urgent care, instead of walk-in care. This benefit will include care provided at both urgent care facilities and walk-in retail health clinics.

So if it is the weekend, and darn it, you’ve fractured your finger, been bitten by a deer tick, or python, or merely sliced your skin wide open for viruses to “come-on-in”–doing something reckless with rusty metal…why delay?  You’re probably covered but ask questions.  Bring your VA ID and see a VA-network doctor close to home–fast!  

by Laura (Kiedove/Guest Author)

BAD THIS YEAR IN NEW ENGLAND— The Lyme disease bacterium, Borrelia burgdorferi, is spread through the bite of infected ticks. The blacklegged tick (or deer tick, Ixodes scapularis) spreads the disease in the northeastern, mid-Atlantic, and north-central United States. The western blacklegged tick (Ixodes pacificus) spreads the disease on the Pacific Coast. Image: CDC  Click for article

This entry was posted in All about Veterans, Food for thought, General Messages, Guest authors, Medical News, non-va care, Tips and Tricks, Uncategorized and tagged , , , . Bookmark the permalink.

5 Responses to When not to “Take the Pain”–New Urgent Care benefit for VA enrollees

  1. john T king says:

    I trust the VA not at all. I have medicare and Cigna, so I don’t depend on the VA at all. I think they will leave you high and dry and you will spend mucho time trying to get reimbursed or get them to pay bills. What’s the difference between urgent care and emergency room care?

    • Kiedove says:

      Emergency care is when your very life is in danger—massive blood loss, car accidents, stroke etc..What’s nice about urgent care is that if you go in with a bad cut that needs more than a bandaid, you can have it taken care of and get a tetanus shot if yours is over 5 years old. Wait time–15 minutes. In an ER, with triage, hours. If the UC doc thinks you need to go to a hospital, they can call an ambulance that will take you there so you don’t have to wait in an ER waiting room. In other words, you’ll get an ER bed sooner, and they send over any tests they’ve done. They may also talk to an ER doc to discuss your case before sending you. The UC > ER transfer protocol is better than, “take a number.”–you are seen by an actual doctor sooner for evaluation.
      They are first come first serve so you just sign in.
      If your life is NOT in danger, and you show up at the ER, insurance can refuse to pay the bill.
      Right now we have original Medicare and a gap policy. The gap policy may become too expensive in the future. We might have to downgrade to Medicare Advantage Plans.
      What I don’t know now is about the duel-enrollment rules. My husband could use the VA plan with no copayment but since they bill Medicare, would he have to pay a Medicare Advantage co-pay or the 20% Original (no gap) co-pay–which could be is around $75.00 or more. VA in most cases is the 2nd and third payers.
      If a vet has NO other insurance, and is 100% liable for the bill, VA is supposed to cover the entire charge minus any VA copay for higher priority vets.
      We need more answers.

    • Kiedove says:

      John, Also, if VA hasn’t paid for any of your care within the last 24 months, you’d need to be seen for some care–eye exam, hearing, flu shot, check-up etc…..You need to check in with them. Medicare won’t pay for the new shingle shots ($300); free at VA for enrolled vets. Or eye glasses; free at VA.
      My husband uses VA for some care, private for some. Plus RX and OTC items. His VA docs have been very good (and smart) so far.

  2. Leona Dunn says:

    No flu shost here at Walgreens in Hot Springs, Arkansas. The reason I’ve been told is because of the high demand. Yes, I called Walgreens Corporate Office to be told they would get back with me in 3 business days. It’s been two weeks.

    • Kiedove says:

      Walgreens may be the only “retail” location to get the VA paid for flu shots this year. My hubby got one in MN a few years ago with his ID. Some VA locations run flu clinics. VA says the urgent care locations may be able to offer flu shots in the future–they are phasing it in. Might be worth checking the location search engine for the approved pharmacies and urgent care centers in your area and call them. Front desk people probably won’t know but the finance/business offices and pharmacists should.
      Let us know how it goes.

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