VA transitioning urgent care network managers

Twenty-three states and Virgin Islands affected


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VA’s goal is to give eligible Veterans who need same-day urgent care for minor illnesses or injuries as many avenues as possible at the right time, right place and right provider.

VA is transitioning its urgent care network managers on Sept. 1, 2020, from TriWest Healthcare Alliance (TriWest) to Optum Public Sector Solutions, Inc. (Optum), which is part of UnitedHealth Group, Inc.

The changes will take place in Community Care Network (CCN) Regions 2 and 3.

VA’s goal is for the transition to be seamless for Veterans. However, the change will result in new urgent care providers being added to its contracted networks while others may be removed.

Minor illnesses at in-network non-VA urgent care providers

Veterans have the option for urgent care treatment of minor injuries and illnesses such as colds, sore throats and minor skin infections at in-network, non-VA, urgent care providers. In addition, Veterans can receive same-day, urgent care treatment at VA medical centers.

Veterans who need urgent care may have the option to use telehealth (phone- or video-based visits) instead of in-person visits at VA or in-network community clinics. Telehealth allows Veterans to conveniently access health care at home while reducing their exposure to COVID-19.

“VA is committed to providing the safest and highest quality health care to Veterans, whether they are receiving their care within VA or in the community,” said Deputy Under Secretary for Health for Community Care, Dr. Kameron Matthews.

Veterans required to pay for out-of-network providers

VA can only pay for urgent care if the provider is part of VA’s contracted network. Veterans who go to an out-of-network urgent care provider must pay the full cost of care.

The change in network management will also affect pharmacies. Veterans who require urgent care prescriptions of 14 days or less can find an authorized in-network provider or contact their local VA medical facility to identify a VA network pharmacy to avoid paying out-of-pocket costs.

States where changes will impact Veterans

The change will impact Veterans in the following locations: Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, North Dakota, Ohio, Oklahoma, Puerto Rico, South Carolina, South Dakota, Tennessee, Wisconsin, and the U.S. Virgin Islands.

Veterans in these states or U.S. territories who need urgent care should use VA’s facility locator or contact their local VA medical facility for help identifying in-network urgent care providers.

Through this unified system, VA continues to deliver care for Veterans at VA and in the community.


Will Ackerman is a strategic communications specialist for the VHA Office of Community Care.

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. Robert Kinsler    

    Some of the Veterans who want answers in SE Oklahoma use Bonham, TX VAMC for their primary care facility while others use Idabel, OK CBOC or McAlister, OK Clinic (Falling under the Muskogee VAMC).

    I guess from the listing that Texas remains under Triwest while Oklahoma is now under this Optum system and the former Triwest urgent care providers are now questioning who the heck is the payer? And some might not even try to figure out the system and simply drop off.

    Now I check both Optum and UnitedHealth Facebook pages and their websites and found nothing regarding this transfer. So in answering the questions I am getting do I transfer these to the VA so they can wait for answers or is their some immediate information I can pass out to inform the veterans in SE Oklahoma?

    By the way, I am the VFW Department of Oklahoma, District 4 Service Officer who has a column in 4 weekly newspapers to inform the veterans in SE Oklahoma what is going on.

  2. Karen E Van Benschoten    

    The VA where I receive care has drastically improved over the last 30+ years. These changes may very well affect the level of care I will receive, both at the hospital and at home, where I receive care from the Home Based Primary Care. The VA is giving me quality care, and I pray that it will affectively continue with my care.

  3. John Hartley    

    I am a veteran but didn’t retire from service. I receive some services from VA Hines. I visit VA regularly, about 3 or 4 times a year. Am I eligible to use this new service?

  4. Humberto Salmon    

    What is the present percentage of disability for earTenitus service connected?

    [Editor: Tinnitus is the most-common claimed medical condition, and the condition that VA most often service connects: https://benefits.va.gov/REPORTS/abr/docs/2019-compensation.pdf ]

  5. Joy Dale Marshall    

    What percentage of soldiers must experience a certain symptom, iillness or disease before it can be categorized as “presumptive”?

  6. Joy Dale Marshall    

    1) When I see a Community Care Provider they bill VA and bill my private insurance. Are they allowed to do that? No, I don’t give them my private insurance info. It already is on file in their computer system because they are part of a University which I have used in the past with my private insurance.
    2) When I am seen by my VA provider, whether it is for primary care, a specialist, a prescription med or imaging they bill my private insurance. I thought if it was “service connected” they would not bill private insurance. What is the standard?
    Thank you for your assistance.

  7. John Braxton Bartlett    

    Community Care is useless to a VA Disabled patient with multiple specialist (including mental health). It is next to impossible to outsource 4 or 5 specialists that will consult across specialists to provide a seriously impaired veteran–true professional Coordinated care and consultation.

  8. Theresa Spencer    

    Where & how do I obtain a list of VA approved community providers?

  9. THOMAS JOHN HARMON    

    After reviewing my Blue Button health record I found that I have a serious heart problem that is causing my severe lethargy and not What I thought were the results of major depression’ IS THIS TRUE? IF SO THAN WHY AM TAKING SO MANY MEDICATIONS FOR DEPRESSION RELATED LETHARGY WHEN THE CAUSE IS IN MY CORONARY SYSTEM AND WHAT CAN WE DO ABOUT INCREASING MY QUALITY OF LIFE?
    The fatigue becomes so severe that I will sometimes sleep for 2 to 3 days getting up only for water or bathroom. I read my Mental reports and while I do agree with most diagnosis I’m miffed at the importance a simple comment can be interpreted. MY LAST THERAPIST PUBLICLY REBUKED ME IN FRONT OF 2 CLERICAL WORKERS AFTER I SAID “WELL, I THOUGHT THAT YOU LIKED ME” SHE REMARKED ANGRILY “I NEVER LIKED YOU” … I was both embarrassed in front of these 2 ladies but cowering,You have no idea how that will destroy self worth.

  10. Wilma Morrow    

    I’m not feeling the excitement…. didn’t even know there was such a thing as VA urgent care besides the VA hospital that doesn’t want us there. (I see VA employees to be able to walk up to the reception and get to make an appointment with ease…)

  11. Francisco Licon    

    Where & how do I obtain a list of VA approved community providers, as well as pharmacies?

  12. Steven A. Lee    

    why is it taking so long to new presumptive illnesses added to the list. Should I file now or wait and have my wife file when I die.

  13. David John Flynn    

    How do get to the VA facility locator?
    You talk about it but do not say how.

    [Editor: https://www.va.gov/find-locations/ ]

  14. Ernest Reaves    

    I have used a VA outsource doctor who has had difficulty With TriWest. I’ve been suffering from chronic back pain for years and have no relief. I really hope this will help. I have almost given up and can’t take the pain any longer.

    1. John Braxton Bartlett    

      A-Men. They do not have up to date info for veterans in the system. And the operate only under strict guidelines of company. They do not and will not represent the best interests of a veteran seeking help to find a specialist authorized by VA. The right hand does not know what the left hand does.

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