The Veterans Choice Program
(VCP) is a benefit that allows eligible Veterans to receive health care
from a community provider rather than waiting for a VA appointment or traveling
to a VA facility.
1. Am I eligible for the Veterans
Choice Program?
To be eligible for the program, you
must be enrolled in VA health care and must also meet at least one of the
following criteria:
- You are told by your local VA
medical facility that you will need to wait more than 30 days for an
appointment.
- You residence is more than a 40
mile driving distance from the closest VA medical facility with a full
time primary care physician.
- You need to travel by air,
boat, or ferry to the VA medical facility closet to your house.
- You face an unusual or
excessive burden in traveling to the closest VA medical facility based on
a geographic challenge, environmental factor, medical condition, or other
specific clinical decisions. Staff at your local VA medical facility will
work with you to determine if you are eligible for any of these reasons.
- You reside in a State or a
United States Territory without a full-service VA medical facility that
provides hospital care, emergency services and surgical care, and reside
more than 20 miles from such a VA medical facility. Note: This criterion
applies to Veterans residing in Alaska, Hawaii, New Hampshire, Guam,
American Samoa, Commonwealth of the Northern Mariana Islands, and the U.S.
Virgin Islands. Also note that some Veterans in New Hampshire reside
within 20 miles of White River Junction VAMC and are therefore not
eligible for the Veterans Choice Program.
2. What if I think I am eligible?
- Call the VCP Call Center at
866-606-8198 or visit the Veterans Choice Program website to verify
eligibility and set up an appointment here.
3. Can I call my non-VA doctor to
make an appointment?
- No, please call the VCP call
center at 866-606-8198 to verify eligibility and set up an appointment.
4. How is the 40 mile calculation
determined?
- This calculation is based on
the driving distance from your permanent residence (or active temporary
address) to the closest VA facility, including Community-Based Outpatient
Clinics and VA Medical Centers. You are eligible if you live more than 40
miles driving distance from the closest medical facility that has a
full-time primary care physician.
5. If I am eligible for the Veterans
Choice Program, can I receive Beneficiary Travel for travel to appointments
with a VCP provider?
- Yes, the Choice Act does
provide funding to pay for travel to VCP providers for Veterans who are
eligible for Beneficiary Travel. However, it did not provide any new
Beneficiary Travel eligibility.
6. If I didn’t get my Choice Card or
I lost my Choice Card, what do I do?
- You do not need your Choice
Card to access the VCP. If you didn’t receive a Choice Card or lost your
Choice Card, simply call 866-606-8198 to find out if you are eligible and
to make an appointment.
7. How do I get my prescription
filled if I use the Veterans Choice Program?
- The community provider you see
through the VCP can issue a prescription for up to a 14 day supply of a
national formulary drug. You may have the 14 day supply filled at any
non-VA pharmacy of your choosing.
- Prescriptions can be reimbursed
through the Business Office/Non-VA Care Coordination Office at VA
facilities. This reimbursement may take 30-45 days to process, and
requires a copy of the prescription and the original receipt. Veterans
cannot be reimbursed at the VA Pharmacy.
- For prescriptions needed past
14 days, please follow standard procedures to fill a prescription at the
VA pharmacy.
8. If I use the Veterans Choice
Program, does that affect my VA health care?
- No, not at all. You do not have
to choose between the two. The VCP is here to make it easier to access the
care you need. VA is building a high-performing integrated health care
network to deliver the best of VA and the community. This integrated
network will give Veterans more choices to access care and ensure care is
delivered where and when you need it.
9. What is my responsibility for
co-payments to my other insurance?
- Nothing. VA is now the primary
coordinator of benefits for VCP, so you are only responsible for your VA
copayment.
- Your VA copayment will be
determined by VA after the care is provided. VA copayments will be billed
by VA after the appointment.
10. How does the new VCP extension
law affect me?
- Public Law 115-26, enacted
April 19, 2017, made three key changes to help improve the VCP. The law
removed the expiration date for the program, made VA primary coordinator
of benefits for services provided to you, and it removed barriers with
sharing necessary health information with community providers.
More Information
- Please refer to the Veterans
Choice Program website for more information about the program, its
benefits, and eligibility criteria here.
- Providers interested in
participating must establish a contract with one of the contractors,
Health Net Federal, or TriWest Healthcare Alliance. For more information,
about how to participate please visit Veterans
Choice Program website for providers.
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http://www.blogs.va.gov/VAntage/39882/10-things-know-veterans-choice-program/
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