Questions answered about Veterans Choice Program
The Choice Program is a new, temporary benefit allowing some veterans to receive health care in their communities rather than waiting for a VA appointment or traveling to a VA facility. It does not impact existing VA health care or any other VA benefit they may be receiving.
A veteran must have been enrolled in VA health care on or before Aug. 1, 2014, or be eligible to enroll as a recently discharged combat veteran within five years of separation. Additionally, a veteran must also meet at least one of the following criteria.
a) The veteran is told by his/her local VA medical facility that he/she will need to wait more than 30 days from his/her preferred date or the date medically
determined by his/her provider.
b) The veteran's current residence is more than 40 miles from the closest VA health care facility.
c) The veteran faces a geographic challenge, such as extensive distances around water or other geologic formations, such as mountains, that presents a significant travel hardship.
VA has signed contracts with two private healthcare companies to help VA administer the Veterans Choice Program. To use the Choice Program, veterans must obtain pre authorization from the national call center at (866) 606-8198.
Issuing Choice Cards
As part of this new program, VA will issue a Veterans Choice Card to every veteran who is potentially eligible for the new, temporary health benefit. The Choice Card allows veterans to elect to receive care outside of VA when they qualify for the new program based on the distance of their residence from a VA care facility, or when wait times for VA health care exceed the standards established in law. The Choice Card does not replace the identification card you already use to access other VA benefits; please do not throw away that identification card.
VA will provide a Choice Card to all veterans who were enrolled in the VA health care system as of Aug. 1, 2014, and to recently discharged combat veterans. The Choice Card will be issued in three phases.
The first group of Choice Cards along with a letter explaining eligibility for this program is currently being sent to veterans who may live more than 40 miles from a VA facility.
The next group of Choice Cards and letters will be sent shortly thereafter to those veterans who are currently waiting for an appointment longer than 30 days from their preferred date or the date determined to be medically necessary by their physician.
The final group of Choice Cards and letters will be sent between December 2014 and January 2015 to the remainder of all veterans enrolled for VA health care.
If a veteran is not eligible to use the Choice Card right now, keep their card in a safe and convenient location. There is no need to call us.
Preauthorization is Required
For all care under the Choice Program, preauthorization for services is required - veterans may not simply schedule their own appointments or visit a community provider and attempt to use the Choice Card to receive care without first obtaining preauthorization.
• It's important that Veterans not seek care without making sure they are eligible and pre-authorized.
• Verify eligibility and obtain authorization by calling (866) 606-8198. When they call, veterans should be prepared to provide any other health insurance coverage they have, such as employer or union-provided health plans, so coverage responsibilities can be assessed.
If veterans do not receive pre-approval, they may be responsible for some or all of the costs of the non-VA treatment received.
If an eligible veteran has another health-care plan, VA is the secondary payer for costs associated with non-service connected care and services furnished to eligible
veterans through the Choice Program and the primary payer for service connected care. This means that veterans using the Choice Program for non-service connected care may be responsible for copays and cost shares associated with other healthcare plans.
When a veteran receives care from an eligible non-VA health care entity or provider, the entity or provider must submit to VA a copy of any medical record information related to the care and services provided. This information will be included in the veteran's medical record.
Frequently Asked Questions
Q: How long will it take to implement the Choice Program?
A: In order to ensure veterans receive high-quality and timely health care, VA is working to implement the Choice Program as quickly as possible. VA will be staging implementation of the Choice Program, with the first round being implemented on Nov. 5, 2014.
Q: How will veterans get their Choice Card?
A: VA will mail the Choice Card to veterans enrolled in VA health care as of Aug. 1, 2014, and to recently discharged combat veterans who enroll within the five-year window of eligibility. Not all veterans who receive the card will be able to participate in the Choice Program — they must meet the criteria established under the new law. VA will implement this program in stages.
Q: When will veterans get their Choice Card?
A: The Choice Card will be issued in three phases. The first group of Choice Cards along with a letter explaining eligibility for this program will be sent by Nov. 5, 2014, to veterans who may live more than 40 miles from a VA facility. The next group of Choice Cards and letters will be sent by Nov. 17 to those veterans who are currently waiting for an appointment longer than 30 days from their preferred date or the date determined to be medically necessary by their provider. The final group of Choice Cards and letters will be sent between December and January to the remainder of all veterans enrolled for VA health care who may be eligible for the Choice Program in the future.
Q: Is the criteria 40 miles or 30 days?
A: Eligibility for the Choice Program is based on the veteran's place of residence or the inability to schedule an appointment within the "wait-time goals" of VHA, which have been established as 30 days from the date preferred by the veteran, or the date medically determined by his/her physician. A veteran could be eligible under one or both of these criteria. Please note that veterans who are eligible based on their place of residence may elect non-VA care for any service that is clinically necessary. Veterans who are eligible based on "wait-time" may select non-VA care only for an appointment for the service that cannot be scheduled within the "wait-time goals" of VHA.
Q: Does the 40-mile rule refer to whether the specialty need (for example, orthopedic surgery) is available within 40 miles, or 40 miles from any VA facility, whether or not the specialty, in this example orthopedics, is available there.
A: The law is clear that eligibility must be based on the distance from the veteran's residence to any VA medical facility, even if that facility does not offer the specific medical service the veteran requires for that particular visit.
Q: What are the criteria used to determine the 40-mile radius? Is it similar to the dashboard used to calculate mileage reimbursement?
A: VA will calculate the distance between a veteran's residence and the nearest VA medical facility using a straight-line distance, rather than the driving distance. VA is developing an interactive tool that will be available on va.gov beginning in early November for veterans to determine their potential eligibility for the Choice Program based on their place of residence. veterans will enter their address information into the tool, and the tool will calculate their distance to the nearest site of VA care, and provide that mileage and information on their eligibility for the Choice Program to the veteran online.
Q. How will eligibility be determined for those veterans who receive a "Choice Card," and are there limitations on what service they qualify for outside of the VA system?
A: Once a veteran receives a Choice Card, they will be eligible to use the program if they meet the specific eligibility criteria discussed above and call to receive approval for use. Veterans who are eligible based upon their place of residence will be eligible to use the Choice Program for any services that are clinically necessary. Veterans who are eligible because of the "wait-time" criterion will only be able to receive a non-VA appointment for the episode of care related to the service that cannot be scheduled within 30 days from his/her preferred date or the date medically determined by his/her physician.
As always please see your local County Veterans Service Officer if you have any questions. You can contact your local VSO at (218) 631-7617 or by email at firstname.lastname@example.org and as always have a great week.