VERIFY YOUR VHIC BENEFITS
Verify Your Veterans Benefits
Addiction is a growing concern among veterans, but help is just an appointment away. Here’s what you need to know about the Veterans Choice Program (VCP). VCP is a convenient benefit that allows veterans to receive health care from a community provider versus having to wait for a VA appointment or having to travel to a VA facility.
1. Who is eligible for the Veterans Choice Program?
There are many requirements that must be met in order to be eligible for the program. To begin, you must be enrolled in VA health care. Veterans must also meet at least one of the criteria below:
- An appointment at a local VA medical facility isn’t available for more than 30 days.
- You live more than 40 miles from the closest VA medical facility that has a full-time primary care physician.
- You must travel by air, ferry, or boat in order to reach your closest VA medical facility.
- Traveling to a VA medical facility causes unusual or excessive travel burdens such as environmental factors, geographical challenges, medical conditions, or some other clinical decision.
- You reside in a state or U.S. territory that doesn’t offer a full-service VA medical facility that offers emergency services, hospital care, and surgical care, and you reside more than 20 miles from the facility. **Note that this typically applies to veterans living in Alaska, Hawaii, New Hampshire, Guam, American Samoa, U.S. Virgin Islands, and the Commonwealth of the Northern Mariana Islands.**
2. How do I confirm if I am eligible?
If you meet the criteria above, the next step is to call the VCP Call Center at 866-606-8198. There is also a Veterans Choice Program website where you can verify eligibility and schedule an appointment.
3. Can I call my non-VA doctor to schedule an appointment?
No, it’s best to call the VCP Call Center at 866-606-8198 in order to verify eligibility. Once verified, the VCP representative will work with you to set up an appointment.
4. How is the 40-mile calculation made?
The calculation for whether or not you live 40 miles away from a VA medical facility is based on the driving distance from your permanent residence (or active temporary address) to the nearest VA facility. Facilities include VA medical centers and community-based outpatient clinics. In order to be eligible for VCP, you must live more than 40 miles driving distance from a medical facility that offers a full-time primary care physician.
5. If I am eligible for VCP, can I receive Beneficiary Travel for travel to appointments with a VCP provider?
Yes, under the Choice Act, you are eligible to receive funding in order to pay for travel to VCP providers if you are eligible for Beneficiary Travel. However, the act does not provide any new Beneficiary Travel eligibility.
6. What do I do if I didn’t receive or I lost my Choice Card?
If you never received your card or have misplaced it, the good news is that you don’t need it in order to access VCP. You’ll want to contact the VCP Call Center at 866-606-8198 to request a replacement card and to make appointments.
7. How do I fill a prescription using the VCP?
There are many options for filling prescriptions if you use the Veterans Choice Program.
- The community provider you see through the program can issue prescriptions for a 14-day supply of any national formulary drug. The prescription can be filled at any non-VA pharmacy.
- Prescriptions are reimbursable through the Business Office/Non-VA Care Coordination Office at VA facilities. Reimbursement can take up to 30-45 days to process, and a copy of the prescription and original receipt are needed. Prescription reimbursements are not processed at the VA Pharmacy.
- For prescriptions that extend past 14 days, you’ll need to follow standard prescription-filling procedures at the VA Pharmacy
8. Is VA health care impacted if I use the VCP?
No, you don’t have to choose between VA health care and the VCP. VCP exists in order to make it easier for veterans to get access to the care they need. The VA is committed to building an integrated health care network so that veterans can receive the best care from the VA and the community. With this integrated network, veterans have more options for health care, as well as improved access to care.
9. Am I responsible for co-payments to my other insurance?
You are not responsible for co-payments to your other insurance. The VA is the primary coordinator of VCP benefits, so you will only be responsible for making your normal VA copayment.
VA copayments are determined by the VA after the care is provided to you, so you will only receive a bill after your VA appointment.
10. How does the new VCP extension law impact me?
The new VCP extension law, also known as Public Law 115-26, was enacted on April 19, 2017 and made three main changes that are designed to improve the VCP. First, the law removed the expiration date for the program. Second, the VA was made the primary coordinator of VCP benefits. And third, barriers were removed so that necessary health information could be shared with community providers.
For more information about the Veterans Choice Program or to determine your eligibility, be sure to visit the VCP website.
If you’re a provider interested in participating in the VCP, a contract must be established with one of the contractors, including TriWest Healthcare Alliance or Health Net Federal. For more information about participating, visit the Veterans Choice Program website for providers.
Looking for Treatment?
Open Enrollment Period – A set period of time that typically occurs in December.
Special Enrollment Periods – Happens after a special event such as a birth, new job, marriage, or if you have lost health coverage.
Your policy effective date is finalized post-enrollment and generally kicks in a few weeks or months after you’ve enrolled with your insurance provider.
If you are dealing with substance abuse, you don’t want to haggle over what your insurance covers and what it doesn’t. You need help and you need it now. Apex Rehab wishes to assist you by streamlining this health insurance verification process.