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VA MISSION Act: Answers to questions about VA’s urgent care benefit
Note: This article is part of a series on VA’s progress implementing the VA MISSION Act of 2018.
Have a sore throat, earache, or strained muscle? Then consider contacting your VA facility or using the community urgent care benefit available to eligible Veterans under the MISSION Act. VA facilities across the country offer same-day primary care and mental health services, and many offer additional services as well. With the new community urgent care benefit, eligible Veterans can also visit a local walk-in retail health clinic or urgent care center that is part of VA’s contracted network. Urgent care providers treat non-emergent symptoms or conditions such as ear infections, minor burns, and mild skin infections.
If you believe your life or health is in danger, call 911 or go to the nearest emergency department right away!
To be eligible for the urgent care benefit, you must be enrolled in the VA health care system and have received care from VA (either in a VA facility or a community provider) within the past 24 months. To check eligibility, contact your local VA medical facility or call 1-833-4VETNOW (1-833-483-8669).
Eligible Veterans can receive urgent care from an urgent care provider in VA’s contracted network without prior authorization from VA.
Top 10 Frequently Asked Questions:
1. How do I find the nearest in-network community urgent care provider?
Use VA’s Facility Locator at https://www.va.gov/find-locations/ and click on the VA-approved urgent care locations and pharmacies near you. There are currently two types of urgent care network locations: walk-in retail health clinics and urgent care centers. Seek care at a retail location for an uncomplicated illness such as a sore throat. Visit an urgent location for more pressing illnesses or injuries requiring services such as splinting, casting, or wound treatment.
2. What do I do when I arrive at an urgent care location? What type of identification will I be asked to show?
There is no identification card needed for VA’s urgent care benefit. When you arrive, verify they are part of VA’s contracted network, complete the intake form, and tell the provider you would like to use your VA urgent care benefit. The provider will check your eligibility. Both Veterans and providers can call 1-833-4VETNOW (1-833-483-8669) to confirm eligibility. Veterans can call 1-866-620-2071 for other issues related to the urgent care benefit.
3. Does urgent care cost anything?
No, you do not have to pay anything at the time of the visit. If you owe a copayment, VA will send you a bill. Copayments are $30, but your liability will depend on your assigned priority group and the number of times you have used your urgent care benefit in a calendar year. Learn more about urgent care copayments.
4. How does prescription medication work for urgent care?
VA will pay for or fill prescriptions for urgent care. For routine prescription medication longer than a 14-day supply, the prescription must be submitted to VA to be filled. Before filling the prescription, VA will verify the urgent care visit. If there are issues with filling your prescription, call 1-866-620-2071.
5. There are no urgent care clinics in my area. What do I do?
Contact your local VA medical facility to discuss options. Same-day primary and mental health services are available at all VA medical centers. In addition, VA continues to expand its contracted network of urgent care providers so that most Veterans are within a 30-minute drive time from their home to a network urgent care/retail location.
6. If there are no in-network urgent care facilities nearby, can I visit an Emergency Department (ED) instead?
If you are having difficulties receiving urgent care services, contact your local VA medical facility. Same-day primary and mental health services are available at all VA medical centers. If you believe your life or health is in danger, call 911 or go to the nearest emergency department immediately. Please note that VA can only pay for a Veteran’s emergency care under certain conditions.
7. Can I use the in-network urgent care provider at my local pharmacy as my primary care provider (PCP)?
No. Urgent care is not a replacement for services your PCP offers. Use urgent care for treating minor, non-emergent illnesses and injuries. The urgent care benefit does not cover preventive health care offered by your primary care physician. Always consider talking with or seeing your PCP if you are concerned that the urgent care provider will not understand the complexities of your medical history or medications.
8. How do I know if I need urgent care or emergency care?
Urgent care is for non-life-threatening illnesses or injuries such as strep throat, pink eye, or a strained muscle. Emergency care is for an injury, illness, or symptom so severe that a prudent layperson reasonably believes that delay in seeking immediate medical attention would be hazardous to life or health. Such life-threatening major illnesses or injuries could include severe chest pain, seizures, loss of awareness, heavy uncontrollable breathing, or severe burns. For emergency care, call 911 or go to the nearest emergency department right away. Please note that VA can only pay for a Veteran’s emergency care under certain conditions.
9. What if I arrive at an in-network urgent care location and have difficulty receiving care?
Veterans can receive a flu shot at their local VA medical facility or from any Walgreens location, paid for by VA. Veterans can also receive a flu shot, paid for by VA, at an in-network urgent care location, but it must be administered in conjunction with a condition requiring urgent care.