How to Use the VA's New Urgent Care Benefit

A new VA urgent care program will let veterans enrolled in the VA health care system visit a civilian urgent care provider for free without an appointment.

The program, effective June 6, 2019, is part of the Department of Veterans Affairs' Mission Act. This new program allows veterans who are enrolled in the VA health care system and who have visited a VA doctor, or a civilian doctor under the VA Choice program, to see an urgent care doctor for free under certain circumstances.

Veterans in Priority Groups 1 to 5, as well as some veterans in Priority Group 6, can visit an authorized urgent care center for free up to three times every year. After that, each visit will cost $30. Veterans in Priority Groups 7 and 8 will have a $30 co-payment for each visit.

More about VA Priority Groups

How to Get Urgent Care from a Civilian Doctor

The VA says that most types of urgent care are covered under this program, including sprains, fever and cough due to cold. You should still go to the emergency room for things like broken bones or chainsaw accidents.

You can get urgent care only from a provider who is part of the VA's contracted network. You can search for a provider online at the VA's website.

Once you find a provider, you should verify with the VA that you are eligible for the benefit and that the treatment you seek is covered under the program. You will probably need to do this only once, but it's a good idea to make sure everything is squared away. If you visit an urgent care provider when you aren't eligible, or you get medical treatment that isn't covered under the new program, you'll be on the hook for the full amount of the bill.

You can call the VA at 866-606-8198, or contact your regular VA medical office to determine your eligibility.

If you are otherwise eligible for travel reimbursement, the VA will also pay your one-way travel to the urgent care center.

After three visits to an urgent care provider within a calendar year, you must pay a co-payment of $30 for each visit. You don't have to pay this at the doctor's office; the VA will bill you for it.

Urgent care visits for flu shots don't count toward the three-visit limit.

However, follow-up visits to the same urgent care provider do count against your three-visit limit. The VA says that you should visit your normal VA provider for any follow-ups.

Prescriptions

If you go to an urgent care provider and are prescribed medicine, you are also eligible for a free 14-day supply of medications related to your condition.

You should try to get your prescription from the urgent care center or VA network pharmacy if possible. Otherwise, you have to pay the full price at the drugstore and then file a claim with the VA to get your money back.

If you need more than a 14-day supply of medication, you will have to get it from your normal VA doctor.

The VA will share your medical records with the urgent care provider as necessary to make sure there are no drug interactions, underlying medical conditions or "doctor shopping" for painkillers that civilian doctors should know about. This will also include information about prescribed painkillers, and possibly mental health and other sensitive medical issues.

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