The Veterans Choice Program allows you to get your VA related health care from civilian doctors in your community. The program was designed to address VA's delays in providing medical care, giving veterans faster access to healthcare.
Who Is Eligible For The Veterans Choice Program?
If you are a combat veteran or were enrolled in VA healthcare prior to August 1, 2014 you may be eligible if ANY of these situations apply:
- You have contacted your local VA medical facility and been told that you can’t schedule an appointment within 30 days
- You live more than 40 miles from the closest VA medical facility
- You must travel by air, boat or ferry to the nearest VA medical facility
- You are faced with an excessive burden due to traveling to the closest VA medical facility. Some accceptable reasons include: geographic challenges, bad weather, medical conditions, or other specific factors as determined by your clinician
All veterans living in Alaska & Hawaii are eligible for the program. Vermont veterans living more than 20 miles from the White River Junction VA Medical Center in that state are also automatically eligible.
You should call the VA at 866-606-8198 to verify your eligibility.
How Do I Make An Appointment Under The Veterans Choice Program?
The VA says that if you are eligible for the program because you live too far from a VA medical center, or there are other issues that keep you from seeing a VA doctor, you should call them at 866-606-8198. They also say that if you live close to a VA medical center but cannot get in to see your doctor within 30 days due to delays at the VA, they will call you (or have their contractor call you) to set up an appointment.
Either way, you don't make your own appointment, you have to provide the name of your doctor to the VA, they will determine if you doctor participates in the program (like insurance companies do), then they will contact your doctor to set up your appointment. You also have to give the VA your insurance information so they can coordinate care.
For example, if you are service connected for sleep apnea and go see a civilian specialst for treatment under this program. While examining you that specialist finds out you have gout, the VA won't pay for your gout treatment.
The doctor will bill the VA for all the treatment provided, but since you aren't service connected for gout the VA will send your insurance company the bill for that treatment. The VA will reimburse the doctor for your sleep apnea treatment.
The VA wants to ensure you get the treatment you need and don't end up getting a huge surprise bill.
What About Copays?
If you have private insurance that requires a copay you don't have to worry, the VA says that if you are getting VA related treatment from a private doctor you aren't liable for any copay. However, if you currently pay VA copayments you are subject to the same copayment requirements under this program. Likewise, if you don't have a VA copay you can see a private doctor and not have to pay them any copay.
Your VA copay will be determined by VA after care is provided, and you will be billed by the VA. If you received treatment for any non-VA related medical condition you may get a copay bill from your insurance company.
What About Prescriptions?
If your private doctor decides you need medicine you will be given a prescription with up to a 14 day supply. You may have the 14-day supply prescription filled at any pharmacy you choose and then submit a request for reimbursement to VA. For prescriptions needed past 14 days, you must get your medications through the VA.