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Veterans Choice Program Frequently Asked Questions

Frequently Asked Questions

Receiving Your Choice Card

Q: What does VACAA stand for?

A: VACAA stands for the Veterans Access, Choice, and Accountability Act of 2014, a law enacted by Congress and signed by President Obama in August to improve health care for Veterans.

Q: When will I receive my Choice Card?

A: The Department of Veterans Affairs (VA) updates its eligibility files on a daily basis to show Veterans who are likely to be eligible to use the Veterans Choice Program (VCP). New Choice Cards are mailed to these Veterans shortly after they are identified, and should be received within 2-4 weeks afterward.

Q: I recently moved. How can I make sure I receive my Choice Card?

A: If VA currently mails you information that reaches your new address, you should have received your card at that address. If you do not receive mail from VA at your current address, you should notify us of your new address by calling 866-606-8198. When a Veteran wants to update their address we take down the new information, but then instruct the Veteran to contact the VA to inform VA of the address change.

If a Veteran needs an address change, they should contact VA directly.

Q: If I enrolled in the VA Health Care System after August 1, 2014 am I eligible to participate in this program?

A: Previously, only Veterans enrolled for care with VA on or before August 1, 2014 were eligible to participate. Now, Veterans enrolled for VA health care may be eligible if they meet the criteria designated by VA.

Q: How many Veterans will receive Choice Cards?

A: All Veterans enrolled with VA for health care, as well as Veterans who qualify to enroll as a recently discharged combat Veteran within 5 years of separation received or will receive a Choice Card.

Using Your Choice Card

Q: Does Veterans Choice Program mean that I cannot receive care from my local VA medical facility?

A: No. The Veterans Choice Program is designed to supplement the care you receive at your VA medical facility, not replace or limit that care.

Use of the card is totally voluntary – a Choice. No Veteran will be required to seek care in the community using the card. In addition, any Veteran currently eligible for VA care will retain that eligibility even if he or she uses the Veterans Choice Program to obtain care in the community.

Q: What benefits does the Veterans Choice Program provide?

A: The Veterans Choice Program provides a safety net for Veterans who are on a VA waiting list because a health care appointment could not be provided to them within 30 days of their preferred date or the date that is medically determined by their physician or who live more than 40 miles from the closest VA medical facility. If you believe those circumstances apply to you, contact us at 866-606-8198 to verify that you are eligible to use the card. Once we determine eligibility, we will help you through the process of obtaining an appointment for care.

Q: How can I ensure I am eligible to use my Veterans Choice Program?

A: If you believe that you are eligible to use the Veterans Choice Program, you should contact us at 866-606-8198 to verify your eligibility to use the card. You may also reference the Quick Facts that were provided to you when you received your Choice Card.

Q: Can I just take my Choice Card to any doctor in my community and have them work with you?

A: No. You should not attempt to use the Choice Card before obtaining approval to use the benefits of the card. Once your eligibility is verified, we will work with you to find a provider within the community who accepts the terms and conditions of providing your care.

If you do not verify eligibility and receive an authorization prior to your appointment, you run a significant financial risk that the services you receive may not be eligible for reimbursement or that the doctor you select may not accept the card.

Q: How will I know if VA considers my home to be more than 40 miles away from the closest VA medical facility?

A: The letter you received with your card will indicate that your eligibility is based on VA's determination that you live more than 40 miles away from the closest VA medical facility.

Q: What if by one route it is fewer than 40 miles and by another it is more than 40 miles?

A: VA calculates the driving distance from your home to the nearest VA medical facility.

Q: Does this program assist with transportation to medical facilities?

A: No, the program does not directly assist with transportation to medical facilities. You may be eligible for travel reimbursement under VA's travel reimbursement program. Please contact your local VA medical facility for questions concerning the travel reimbursement benefit.

Q: Can I utilize the Veterans Choice Program to see a primary care physician for a routine check-up?

A: You may be eligible to use the Veterans Choice Program for primary care services if you live 40 miles from the closest VA facility or if you tried to schedule a primary care appointment with VA and you were told you would have to wait more than 30 days for care. Please call us at 866-606-8198 to determine if you are eligible.

Q: Can I select my own medical provider or can I only use certain providers recommended by VA?

A: When you contact us to verify your eligibility, we will work with you to find a provider within the community who accepts the terms and conditions of providing your care. Please know, there is no guarantee that the provider you prefer will accept the Veterans Choice Program. We will make every effort to work with the provider. Ultimately, however, if the provider won’t accept the Veterans Choice Program and you still choose to see that provider, you may be responsible for all costs associated with your care.

Q: How do I schedule appointments through this program?

A: Just give us a call at 866-606-8198 and we will walk you through the process of making an appointment.

Q: What communication options are available for Veterans with hearing or speech disabilities?

A: TriWest Healthcare Alliance is pleased to offer options to help Veterans with hearing or speech disabilities communicate telephonically.

711 for Telecommunications Relay Service: Our Contact Centers accommodate calls from the Telecommunications Relay Service (TRS). TRS is available in every state, as well as Guam, American Samoa, and Northern Mariana Islands, at no additional cost to the caller, and provides basic relay services to hearing or speech disabled individuals using text telephone (TTY) devices. To communicate with TriWest using this service, please use your TTY or dial 711 on your telephone.

AT&T National Relay Service: Our Contact Centers also accommodate calls from the AT&T National Relay Service. The AT&T National Relay Service is available at no additional cost to the caller and covers a range of communication methods. To communicate with TriWest using this service, please use the following resources:

Q: How will I ensure my medical records are returned to the VA Health Care System?

A: We'll take care of that! If you've seen a provider that we identified for you from among those providers in the network or a provider who has agreed to accept the Veterans Choice Program, then that provider has also committed to returning the medical documentation related to your visit. We will reach out to the provider and ensure those records make it back to VA.

Q: I don't think I am currently eligible to use the Veterans Choice Program. How do I become eligible and who do I speak with to confirm my eligibility?

A: If you're not eligible today, you don't need to do anything. But, remember, you may be eligible in the future to use the Veterans Choice Program. So, keep your card in a safe and secure place.

Q: I prefer to use VA medical facilities for my health care. Will the Veterans Choice Program help me secure appointments at VA medical facilities where I have been waiting more than 30 days for care?

A: You can always choose to receive your care from VA directly. However, the Veterans Choice Program will not directly help you schedule an appointment with a shorter wait time through VA. It is intended to ensure that Veterans have a choice to seek care from community providers if they face lengthy waits for necessary care from VA facilities.

Q: If a community provider recommends I see a specialist, will that be covered by the Veterans Choice Program?

A: Not always. If you are eligible to use the Veterans Choice Program and you see a doctor who recommends that you see a different specialist for your care, the provider should notify TriWest of that recommendation so that we can ensure your care is provided by a network provider and that the care is authorized.

Q: Does the Veterans Choice Program provide for hospital care if my local physician recommends it?

A: If you are eligible to use the Veterans Choice Program and you see a doctor who recommends that you be admitted to a hospital, the provider should notify TriWest of that recommendation so that we can ensure your care is provided in a network facility by a network provider and that the care is authorized and will be fully reimbursed.

Payment Questions

Q: Does this card pay for any prescription drugs I may need?

A: In general, VA will continue to provide Veterans with any and all prescription medication you might require for care or treatment. In certain urgent and emergent circumstances, you can obtain a 14-day supply of medication from a local pharmacy and VA will reimburse your out-of-pocket expenses. However, we strongly recommend that you understand the circumstances under which VA will reimburse you for the costs of the medication. Please visit our Quick Reference Guide for more detailed information.

Q: Will I have to make co-payments when using the Veterans Choice Program?

A: The law requires that Veterans using the Veterans Choice Program make co-payments in the same manner as they would be paid for care or treatment from VA. In addition, the law also requires VA pay secondarily to any private health insurance you might have. When your commercial health insurance covers the costs of your care, then you may need to make co-payments or pay other expenses pursuant to the terms of that plan. If you owe any co-payments to VA, you will receive an invoice from VA after your care has been provided in the community.

If you do not select a health care provider who has agreed to participate in the program, you may be a risk for substantial out-of-pocket costs related to your visit.

Utilization Management (UM)-40 Mile Eligible Veterans

Q: What is UM?

A: Your VA Medical Benefits Package only covers care that is determined by a medical professional as “needed to promote, preserve, or restore the health of the individual and is in accord with generally accepted standards of medical practice.” The process of making those determinations is Utilization Management (or “UM”). During UM review, TriWest will work with you and your doctor to get the necessary clinical information needed to make a decision. Once the information is obtained, it is reviewed by a nurse or doctor and compared with nationally recognized standardized guidelines to approve or deny the requested care.

Q: How long does the review take?

A: Most UM reviews are completed within 3 business days.

Q: How will I know the result of the UM review?

A: After the UM review is completed TriWest will attempt to contact you.

Care Approved: TriWest will attempt to contact you by phone to assist you with scheduling an appointment.
Care Denied: TriWest will attempt to contact you by phone if your care is denied and will also send you a letter that provides instructions on next steps.

Questions Covering Private, Commercial Health Insurance

Q: I am partially covered under my spouse's insurance. How does the Veterans Choice Program affect that?

A: It is important to know that VA is considered a secondary payer to any other private health insurance you may be eligible for when you use the Veterans Choice Program and for the treatment of a non-service-connected condition. As such, you will need to provide information about your private health insurance plan in order to use the Veterans Choice Program.

Q: I have private insurance. Should I drop it?

A: The decision to maintain or drop your private health insurance is a personal matter. VA does not require that you maintain private health insurance. Additionally, the Veterans Choice Plan does not affect any coverage you may have through your own or a spouse's insurance. You should evaluate your decisions on any private health insurance you currently have according to your own unique health and financial circumstances.

Q: I have Medicare, how does it apply when I use the Veterans Choice Program?

A: Medicare, Medicaid, and TRICARE are not considered as OHI for the purposes of the VCP. These plans are not billed by the VCP provider and the Veteran is not responsible for any Medicare, Medicaid or TRICARE cost-shares under the Veterans Choice Program.

Q: I have TRICARE, how does it apply when I use the Veterans Choice Program?

A: Medicare, Medicaid, and TRICARE are not considered as OHI for the purposes of the VCP. These plans are not billed by the VCP provider and the Veteran is not responsible for any Medicare, Medicaid or TRICARE cost-shares under the Veterans Choice Program.