VA MISSION Act: Answers to top questions about community care appointments



Note: This article is part of a series on VA’s progress implementing the VA MISSION Act of 2018.

With the implementation of the MISSION Act, eligible Veterans have more convenient choices for getting timely, high-quality health care. Veterans eligible for community care can choose to receive care from a VA medical facility or a community provider in VA’s network.

This article answers some common questions about making community care appointments.

1. When will I be referred to a community provider?

Eligibility for community care depends on specific eligibility criteria, and your care team can help you understand your options if you are eligible. In most situations you can choose to receive your care in VA. If you are eligible and do choose to receive care in the community, you must receive approval from VA before receiving care to avoid being billed for the care. Emergency care and the community urgent care benefit are exceptions; you do not need prior approval for these types of care, though you may have a copayment for receiving such care.

2. How do I find a community provider near me?

You can either choose your preferred community provider or a VA staff member can help you select one. The selected community provider must be part of VA’s network of community providers and must be an eligible provider. VA’s network includes (1) providers that participate in regional community care networks that are managed for VA by third-party administrators under contract with VA, as well as (2) other community providers with whom VA contracts directly for certain services. A VA staff member will be able to confirm if you can go to a specific community provider.

To find an in-network community provider near you, use the VA Facility Locator. Before an appointment is scheduled, make sure to confirm that you are authorized to receive this care and have received a referral from VA to see the community provider.

If your preferred provider is not in VA’s network, VA may be able to add the provider to its network, or you can choose to schedule with a network provider that offers the same care.

3. How do I schedule a community care appointment?

Once an eligible community provider has been selected, VA will send you and the community provider a referral. VA will also send any pertinent medical documentation to the community provider to ensure proper care coordination between your VA care team and the community provider.

There are several options for scheduling an appointment, depending on the type of care you need. Your VA medical facility will work with you to identify the scheduling options available to you.

You may be able to:

  • Directly schedule an appointment and inform a VA staff member about the appointment.
  • Request an appointment by logging into My HealtheVet and using the VA Online Scheduling application for certain types of routine services.
  • Ask a VA staff member to schedule the appointment.
  • Ask a VA third-party administrator (TPA) to schedule the appointment.

4. It’s been five days since I was approved to see a community provider, and no one has contacted me to schedule my appointment. What do I do?

If you are experiencing delays in scheduling your community care appointment, please contact your VA medical facility for assistance.

5. My appointment was cancelled. How do I reschedule?

You may reschedule an appointment with your community provider when scheduling issues arise or contact your VA medical facility community care office for assistance.

Click here for more information on making community care appointments.

Author

VAntagePoint Contributor

— VAntage Point Contributors provide insight and perspective on a wide range of Veterans issues. If you’d like to contribute a story to VAntage Point, learn how you can submit a guest blog at http://www.blogs.va.gov/VAntage/how-to-submit-a-guest-post/

Comments

  1. Linda Davies    

    I called the VA to schedule a simple eye clinic appt a month ago. I was told the clinic was booked and was referred out to Triwest. I have yet to hear from them, much less have an appt booked. At this point I would have been better off just waiting on a VA clinic appt. I’m about to contact Patients’ Advocate. When I try to call the community care clinic and ask what is going on all i get is voicemail, which I leave and it never gets returned. I’m sorry, I know a lot of y’all have much worse problems than i do. But it really shouldn’t be this hard. I didn’t think it was possible to make scheduling appts with the VA worse, but Triwest has surely done it.

  2. RaeAnn James    

    I need to see an outside OB/GYN doctor because of issues that I have had in the past. I was told a year ago that because of these issues that I would be approved to see the outside MD. Well, today, I was told by the clinic doctor that my request has been DENIED!! Why? I was told that the clinic doctor can perform part of the testing that I need. I have only seen this doctor 1x for a physical. She is NOT a specialist in OB/GYN issues as my outside MD is (I have had this doctor for 7 years); NOW WHAT?! I guess I go with these tests since this whack job of a doctor won’t approve the outside MD. I have no other insurance so I guess I take my chances. As far as I’m concerned the VA MISSION ACT is a total joke.

  3. RaeAnn James    

    I don’t think this VA Mission Act is worth the paper that it is written on. I have had several issues in the past regarding biopsies and possible cancer. I no longer have outside insurance. I asked the VA if they would give me a referral to the doctor that I have had for 7 years and is following me closely and I was told “Referral Denied” because what you are asking for can be done “in house”. I think not! I don’t want a stranger who is not a specialist in this particular field touching me in any way. I guess I take my chances and not have the tests done and pray that nothing happens. Pretty sad when a VA doctor that is only in the clinics for a couple of years can dictate whether you should be seen by a primary doctor on the outside.

  4. John Sprague    

    Got a referral for non-VA care 3 Sep 2019. They sent me a letter mid Nov saying they tried to call me. Checked my Smart phone…they never called.

    For the following two weeks,I tried to call them a dozen times, but they never called back.

    Last week, they cancelled the referral. Do ya think that this is health care? I dont. If they are that far behind, someone should take prompt action to hire and train enough people to get the job done. 3 months have passed and still they have yet to even try to contact me for an appointment. Sending letters lying about contact attempts triggers VA regulations so they can cancel the referral. That is one way to get the back log down!!

  5. Mark White    

    I’ve got nothing but praise for the va at Togus Maine .5 stars. Portland maineclinic. Primary care is more than that. Great job. They should quickly replace Drs. And nurses when someone leaves to lessen the load. Mark

  6. L. Bayer    

    On April 97,2019, I notified the VA via the VA email system that I had a painful growth on the back of my head that appears to be cancerous. The VA scheduled me for an appointment for July 19 (over 90 days out).

    On April 23, due to extreme pain and bloody appearance of the lesion, I went to the Parkview Emergency Center located in Pueblo West, Colorado. After an examination, I was diagnosed with an “Acute unidentified lesion to the scalp, possible basal cell carcinoma.” Parkview staff requested that I immediately get an appointment with a dermatology office. I contacted the VA immediately via email and asked for assistance.

    On May 06, 2019 I received a phone call from a VA doctor in Denver who informed me that I needed an biopsy taken from the sore on the crown of my head. After some discussion, it was decided that the VA doctor would refer me to VA Tri West to schedule an appointment with a Pueblo dermatologist. On May 15th I phoned Vanguard Skin Specialists located in Pueblo and arranged for an appointment for Monday, May 20 for consultation and a biopsy if needed. During the May 20th appointment, I was advised that I needed an immediate biopsy, but it would take approximately 30 days to get approval from the VA to perform the biopsy. I decided to have the biopsy performed that day and that I would pay for the operation myself. The dermatologist took two biopsies that came back cancerous. After three more biopsies and four operations to remove cancerous areas, I was advised to contact the VA and advise them that my cancerous conditions could be related to my exposure to “Agent Orange” back in 1966 and 1967. As of this date, no response from the VA.

    In 2018, I had to personally pay to have cataract surgery performed in both eyes because the VA could not give me an approval after five months of waiting.

    ,

  7. Edward Aboud    

    I’m a veteran out of Phoenix TriWest we’re supposed to mail me some paperwork and they fail to do so not once but two weeks in a row they still couldn’t mail a letter till I went down to the action center at the VA Center and they took care of it. TriWest is the most pathetic organization of ever seen in my life there worse than the VA that’s kind of hard to do. Get with the program you people can spend billions of dollars take care of illegals that come across our border and treat them for PTSD but you can’t take care of the veterans that has fought for this country how pathetic is that

    1. Juan J Gonzalez    

      Quit blaming illegals for all your problems and do something for yourself.

  8. Dennis Heath    

    I have a new primary care Doctor and I real don’t care for him. Is there anyway I can find a new one. I really don’t think he has my health care is very important to him.
    I don’t know who I can talk too and Afraid that I will be black balled. Because I said anything.
    I Have questioned about my hip replacement. Why they did it the way they did. I have other things I like to talk about.
    No one understands about my health
    Life is no fun at all and when you hurt
    Just a veteran that is unhappy and afraid of what mite happen since I said anything.
    One Vet that is in pain and asking for help.

  9. Joe    

    Call the Trump hotline. You will get help from this call center. Just do a Google search for the telephone number.

    1. Thomas A Whittingham Sr    

      Contact the patient advocate at your local VA Hospital .

  10. John Manley    

    The Mission Act appears to just be lipstick on a pig to make politicians feel good about themselves. As far as i can see it has changed absolutely nothing in regards to getting anything close to prompt medical attention, from either the VA system or community care. Just more hoops to jump through to get scheduled 2 months out for an appointment that will highly likely be cancelled a few days before the visit is scheduled. Only to have to reschedule and start the waiting game all over again. Guess its good i dont have some serious issue that needs looked at.

  11. Udo fischer    

    I am a 90yo 100% disabled veteran (80% CR) and am very pleased with my VA providers, dental and clinic, about 70 miles away from where I live. Several times I received referral to a local area provider without delay.
    I have no complaints.

    1. Thomas A Whittingham Sr    

      Wait till you get sent to a local provider and six months to a year later you get a denial of payment for the service they approved. I agree lipstick on a pig.

  12. Craig Coburn    

    Apparently the Dallas/Ft Worth VA doesn’t know that this exists, or just doesn’t want us to take advantage of it. Nothing has changed, and nothing ever will.

  13. douglas keith niles    

    turning out to be mission impossible.

  14. James H Weaver    

    Hey Vets get off your butts and make your own appts. with an approved VA community care provider and just let the VA know that’s what I do and have little problems. Consider all fake claims the VA has to look at in my opinion they do a good job if you know how their system works. Do your homework.

  15. Joseph ford    

    Beckley WV, VA gave me a choice to go community care for dermatologist if wait was over 30 days. I chose to wait a couple weeks longer and stay at VA.

  16. kristy west    

    This all sounds wonderful however the process takes months!! Seriously, I thought this was supposed to take care of the problem of not being able to be seen by the VA for months.
    Is the executive leadership of the VA aware that this process isn’t working. The idea is brilliant, the execution is flawed.

  17. Joe Brown    

    Hell they lied to us 50 years ago when we came back from that Vietnam hell hole and have lied ever since.They don’t want us old Vietnam vets around as we are a sore in their a**.

  18. Jack    

    I am very grateful for this because my nearest VA is about 50 miles away. The only issue I have with it, is that I can only use this 3 times in a year before I will be charged a copay.
    So, I can only get sick/injured 3 times in a year, then I must pay for the convenience to visit a local Urgent Care. My medical insurance has a $30 copay, now the VA will have a $30 copay for Priority Group 1 veterans after 3 visits for a service I can get for free? I would just have to drive the 1 hour, 50 mile trek to the VA Urgent Care during normal business hours because they are closed during NON-business hours. Can you see when I’m going with this?

  19. Timothy Fullerton    

    How do I get my Dentist payed for work he performed back in May. The office has submitted all the paperwork?
    I’m too embarrassed to make an appointment for issues I’m having now.
    I’ve always payed my bills. Should I go to savings and pay it myself.

    Tim Fullerton

  20. Michael Sewall    

    The community care I received was good, however VA never pays the bill for community services and they go after me for payment, twice I’ve used community care and neither bill was paid until I turned the bills over to my Congressman, it took about 6 weeks but they ARE paid.. Shouldn’t have to end up with unpaid bills on your credit report that VA never pays!!

  21. Art Kretzschmar    

    This is a joke… it never gets past the inquiry stage… here in NJ my doc told me flat out 99% of requests are disapproved so don’t bother. It is all lip service.

  22. David A Packard    

    I was approved for dental care with an outside VA dental contractor. I get to my appointment and after the Dr. Inspects my teeth he tells me that he disagrees with the VAs dental that it was the wrong treatment for my problem, that it was only a bandaid treatment and he would get in touch with the VA to discuss the right treatment for me.
    In the end it turnout the VA unapproves MY TREATMENTS with the outside dental care and now I an stuck back with the VA for them to do unethical treatments for my problems. I hate the VA. I wish I never had to go to the VA for anything.
    The same va knew I had cancer and according to am outside lab in a letter to sent the va that said I had esophagus cancer and I needed immediate attention, I was never notified and the cancer was allowed to fester for 1 year until I found the letter form the Maryland federal lab and gave a copy to my va oncologist. My pc dr wouldn’t refer me to outside at first but after pushing the matter to my oncologist it was taken care of at Wake Forest hospital. They removed a 12mm nodule and I am recieving ablation treatments now.
    I hate the Salisbury VA system.

  23. David    

    I was approved for Community Dental Care 6 months ago. I call the VA Hospital in PA. every 3 weeks for updates and still no Provider in my zip code area. I have Dentists right in my town. VA awarded Optum Serve out of Virginia a $55 Billion contract to provide Community Care Services for Veterans. Optum is not helping Veterans in my area. I was also told that VA can suggest local providers to Optum for care in a Veterans area, but they, (Optum) do not have to use that provider. What good is this contract to help veterans, if they won’t use providers closer to the Veterans home.

  24. Gary Hammon    

    I can not even get an answer on the “Find VA Locations” when searching for Community Care (Non-VA Health), Primary Care. It states your results should appear in less then a minute. It never works. It will sit there spinning for hours to days. I have to go to a VA clinic or hospital to get the answer I need because this on line system does not work, or does not work for my area. Just more poor service to Vets.

  25. Patrick Fitzpatrick    

    This new program takes longer and is less understood than the old Choice Act! Primary Care Providers, specialists, and other VA personnel DO NOT UNDERSTAND the program let alone its intent!! To extend care previously approved (only authorized for six months maximum) veteran must get a new appointment with primary care, be referred again to specialist, who then puts in a new consult that sits for months in a “secret community care center somewhere!!” The “community care division/office” is NOT ACCESSIBLE to Veterans, its more secretive than the CIA!!!! Phone numbers change often or do not work. The only thing a Vet in the Atlanta area can do is leave a message with a call center and “hope” someone calls!!! (They never do). Patient advocate!s office is overrun with Veterans seeking help. No one seems to understand the Act’s provision “if treatment is in the best interest of the patient!” Mileages and driving time do not account for “traffic delays” that greatly increase travel time! Veterans feel as if the VA does not want the program to work and therefore ignore the law and intent of Congress and the President! VA IG needs to get involved!! Given the Atlanta VAMC is rated a 1 (lowest standard of care) on a scale of 1 to 5, both the dental clinic and operating rooms have been closed for periods of time for “a number of problems?” Is anyone really surprised? Does anyone really care? So the Saga continues!

  26. Richard LaRouche    

    The mission act is a joke where im at. It literally takes an act of congress to get appointments. 3 or 4 dozen phone calls and nothing gets done. I suffer from peripheral neuropathy and paralysis and getting in to see a actual specialist is impossible

  27. Dortha Taylor    

    I have suffered for 13 and a half years because of the VA Hospital in Salt Lake City Utah. Because I was denied Treatment and told there was nothing wrong. I was treated badly by primary care physicians. I Moved back to Oklahoma. And was Seeing Emergency Room Doctor and started getting better until primar care in the women clinic. Then she said nothing was wrong. Well there was I had to go outside the VA for Help. I’m getting Better. I got a letter from the VA stating I qualify.for community care but since the mission act said I don’t qualify. And refuses to answer my calls then they said Ithey weren’t pay for my doctor that is going to fix my broken Thumb. Because the did choose him. Well . I’ve had a broken Thumb for over a Year the VA said it wasn’t broken, I finally found a good orthopaedic surgeon. . My Thumb is broken I can’t function. I can’t write my name without pain.and that’s just one of my injuries. The list goes on.. I called the crises line and the Washington Hot Line. I’ve talked with the suicide prevention coordinator. They just now gave me a new primary care doctor. I can’t drive that far..

  28. Larry Lacey    

    Please stop telling us we don’t need approval to see out side I went to my local area ER because I am 50 miles from Dallas VA ER and the ER put me in the hospital because of on control BP I got a letter from Dallas saying they will not pay and the bad thing about it it took them 2 yrs to send me the letter and they said it had not been approved before hand

  29. Thomas Carlucci    

    I am a Disabled Veteran, 70%. I live with never-ending pain. I have no family and need some help at home. BUT–I have been told I make too much money for a provider. So, I have to get one on my own, but I cannot afford TWENTY DOLLARS AN HOUR! Here I am, a disabled Veteran who legitimately needs help–but because I can dress and bathe myself I am told I don’t qualify. It is terribly painful for me to clean my apt, do laundry, even stand up to cook. IS THERE ANYONE IN THE COUNTRY who can find a way to get me a provider for maybe one or two days a week?

    1. Rick    

      Check with the local VAMC closest with you and ask to talk with or see a social worker that can assist you in seeing if you qualify for in home care. Here in Long Beach Ca, they send out a care worker 3 days a week, no cost to the Veteran.
      Hope this helps.

  30. Alice Eldridge    

    You say to contact the VA to get help if you have not heard from Community Access in 5 days, however, my provider told me my referral was approved TWO MONTHS ago and I still have not been contacted. How long do we wait and exactly WHO at our VA does one speak with. Vets at my VA have been given no information the Access program other than the generic press releases and absolutely no information re who we can get help. Do we need to start working with our Senators or the President??????!!!!!!!

  31. David Sayler    

    Though there is a mission act. The time it takes for approval and getting a doctor is several months. Your PCP is out two months or more, so the problem is still not fixed.

    1. David Vincent    

      The mission act is a total joke. I need major back surgery and am almost unable to walk (service connected and just getting worse) It has been 9 weeks since the referral was put in. I called at 4 weeks and was told it takes 6 to 8 weeks. Tomorrow is thanksgiving and still no help. Had I stayed with the VA I would have been closer to the operation they said I need. I asked for outside help since the wait is so long and was told it would be mid December before the surgery or as late a Jan 2 or 3. At this point since I have not even seen the referral let alone the surgeon I chose (he operated on my neck for the same kind of problem 3 years ago and it has been wonderful) He will likely be out 2 or 3 months now with all the holidays.
      What a joke the VA has become like the old joke Trust Me I am From The Government And Here To Help….it is more like they are waiting for you to die so they can save money.

  32. Arnold Cabral    

    Veterans and People who read this email your Senators or Representative contract Veteran Affairs Committee passed a Veteran Benefit Law for Disabled Veterans who is 100 percent service connected needs a Dentist know how to G4 implants for free because they don’t have one work for Veteran Medical Centers or have a contract with Veteran Administration and if a Disabled Veterans who is 100 percent service connected doesn’t get the G4 implants it would cause really bad Health problems plus it would cause really bad Gums Disease also it may cause Cancer.

  33. Mark    

    Go figure they are just repeating from one lie to another . Vietnam vet 1971 .

    1. Joe Brown    

      Hell,the government lied to us 50 years ago when we came back from that Vietnam hell hole…they lied to us ever since. They even lied to Desert Storm vets.They don’t wnat Vietnam vets around…we are a sore in their a**.

  34. Thomas Ybarbo    

    What can you do when it takes VA Dallas over 3 months for approved veteran to see a community care doctor requested due to a serious injury. I questioned everyone in VA about the 3 + months it is taking VA to approve my request for Community Care and all I get is VA Dallas is 20,000 consults behind and only 3 people working on them. Poor Service to Veterrans from VA Dallas Community Care

    1. Karen Kowerman    

      Call and get on their ass! It’s your responsibility to follow-up

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