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Be informed guide
All Veterans receive coverage for most health care services such as regular checkups with your primary care provider, appointments with specialists, medical equipment, prosthetics, and prescriptions, but only some will qualify for added benefits like dental care. The full list of your covered benefits depends on:
For more information on VA eligibility and priority groups visit:
https://www.va.gov/health-care/eligibility/
Where to Receive Care
VA Health Care provides medical care and services for veterans in two main ways:
1
VA Care Locations
May also be referred to as Veterans Health Administration (VHA)
2
Community Care Network
Community Care Deeper Dive
The first step is to meet with your VA physician and discuss your care and treatment options. In order for a veteran to receive care through the VA Community Care Network, a VA staff member must determine if at least one of the following criteria is met:
It is in the Veteran’s best medical interest, as determined by the VA provider.
A service is needed that is not available at a VA medical facility.
Veteran lives in a US state or territory without a full-service VA medical facility.
Veteran qualifies under the “Grandfather” provision related to distance eligibility for the Veterans Choice Program.
VA cannot provide care within certain designated access standards.
Veteran needs care from a VA medical service that VA determines is not providing care that complies with VA’s quality standards.
Optum Covers regions 1, 2, and 3
TRIWEST Covers regions 4 and 5
VA Community Care Contact Center
Example of a Veteran’s journey through the VA Community Care Network
Eligibility
1
Veteran seeks care from VA.
2
VA determines, based on specified community care criteria, that veteran receives care from a facility in the community care network
Appointments
3
VA engages community care provider to accept referral and method of delivery (referral packet includes medical record)
4
Once referral is accepted, either VA schedules appointment with community care provider or veteran schedules appointment
Getting Care
5
Veteran receives care from community care provider
6
Provider sends medical record to VA.
Billing
7
Provider bills Optum or TriWest for the care.
Visit https://www.va.gov/COMMUNITYCARE/about-us/support.asp or call the Office of Integrated Veteran Care (IVC) at 877-881-7618
Disclaimer: The information on this site is intended for U.S. residents only and is provided purely for educational purposes. Health, legal, regulatory, insurance, or financial related-information provided here is not comprehensive and is not intended to provide individual guidance or replace discussions with a healthcare provider, attorney, or other experts. All decisions must be made with your advisers considering your unique situation. © Triage Cancer & Pfizer Inc. 2024
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