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
or VA Urgent Care Pharmacy Locations
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.
* “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)