VA Community care – I don’t want a bill!

From Keeyawnia “K.C.” Hawkins, Veteran Service Officer In-Charge

VA provides care to Veterans through community providers when VA cannot provide the care needed. Community care is based on specific eligibility requirements, availability of VA care, and the needs and circumstances of individual Veterans. With that being said we wanted to provide you with a few tips that will make navigating the VA Community care program more user friendly. 

1.   Make sure your community care is authorized before making or attending any appointments. 

a.   This will help to ensure that you are not billed for care. 

b.   A CPT James A Lovell FHCC Community Care Coordinator should reach out to you when they get approval on your community care referral. If they don’t reach out to you, feel free to give them a call at 224-610-8632 to inquiry about the status of your Community Care referral. 

2.   If you are accessing this care as a Veteran with service connection greater than 50% or if you are service connected for the condition in which you have the community care referral for, please be sure to keep a copy of the Approved Referral for Medical Care (VA Form 10-7080) and bring it with you to your appointment.

a.   This will help to ensure that you are not billed for the authorized care.

b.   This also helps to prevent the community provider from attempting to bill other medical insurance instead of the VA, which may inadvertently cost you in the form a co-payments and deductibles associated with your other medical insurance policy.

3.   If you use your VA.gov account, you can request a copy of the approved referral for medical care be sent to you in the medical portal (also known as MyHealthEVet). That way you know exactly where a copy of your referral is located, and you will also be able to communicate with the community care coordinator about the referral when needed. You can also call Lovell FHCC Community Care (224-610-8632) and request a copy of the referral be mailed to you.

a.   When is it needed to communicate with VA Community Care? – When the community provider wants to do additional testing or if you are unsure if the services the provider wants to provide are covered in the community care referral.

b.   This will help to ensure you are not billed for the care. 

4. Lastly, if you find yourself needing to get EMERGENCY care at a non-VA facility here is what you need to know. The VA will only cover emergency care when you meet certain requirements.

a. You do not need preapproval, but the facility must be an emergency department. If you think your life is in danger, call 911 or go to the nearest emergency department. This is one of the few instances it is ok to get care before informing the VA. 

b. You must notify the VA within 72 hours either through the VA emergency care reporting portal (https://emergencycarereporting.communitycare.va.gov/request) or by calling 844-724-7842. Failure to report the care with 72 hours or getting any care that is not considered emergent may result in getting billed for all the care. 

As a general rule authorization is required before any care or service begin. Never assume all care is covered. If follow up appointments are scheduled inform your Community Care Coordinator. Communication with your coordinator is key to preventing unexpected and unnecessary medical charges. 

If you have a question for the VSO’s, email it to veterans@lakecountyil.gov with a subject line of “VSO Newsletter question”.