Community Care for Veterans - VA San Diego Healthcare System
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VA San Diego Healthcare System

 

Community Care for Veterans

VA coordinates health care for Veterans from community providers in the local San Diego area. Veterans may be eligible to receive care from a community provider when the VA cannot provide the care they need, or the wait time for their care exceeds VA wait time standards or the drive time exceeds VA drive time standards. This care is provided on behalf of and paid for by the VA. Community care is available to Veterans based on certain conditions and eligibility requirements. A VA provider must first approve community care before a Veteran can receive care from a community provider.

What is the VA MISSION Act?

On June 6, 2018, President Donald J. Trump signed landmark legislation known as the VA MISSION Act of 2018. The Act affects many VA programs, including changes that make dramatic improvements to how Veterans receive health care provided outside of VA facilities.  With the implementation of the MISSION Act, the Veterans Choice Program ended.  For more information, please read the Veteran Community Care General Information fact sheet. 

Will I be eligible for community care under the MISSION Act?

You may be eligible for community care if:

  • You need a service that’s not available at VA (e.g. maternity care).
  • You reside in a U.S. state or territory without a full-service VA medical facility.
  • You met previous distance criteria or live in one of the least populated states (ND, SD, MT, AK, WY), received care prior to June 6, 2018, and receive care within two years after June 6, 2018.
  • You meet average drive time or appointment wait-time requirements.
  • You need care from a VA medical service line that isn’t providing care that complies with VA’s quality standards.

For more information, please read the Veteran Community Care Elligibility.

***Important Message***

Veterans, if your care is referred to the community, please make sure to provide your scheduling preferences to the VA scheduling clerk when they call you to make the scheduling attempt with the VA. These preferences consist of your preferred community provider, preferred appointment date/time, and how far you are willing to travel for your care.

By providing these information, you will ensure we schedule you with your preferred provider timely. Once we coordinate your care, your community care appointment is scheduled directly by the community provider, not by VA. The VA will mail you your community authorization information. 



Helpful information related to VA MISSION Act

  • Veteran Community Care – Emergency Care

    Beginning June 8, 2020, the VA is requesting that Veterans and all community hospitals and/or community providers notify the Department of Veterans Affairs (VA) of a Veteran who self-presents to an emergency department within 72 hours of the start of the episode of care.

    This notification should take place through the VA Community Care Centralized Call Center (Call Center):
    Email: VHAEmergencyNotification@va.gov
    Phone: 1-844-72HRVHA or (844-724-7842) 
     
    See VA Community Emergency Care - Provider Notification for details.

  • Veteran Community Care – Urgent Care 

    This is a 7-page document that provides detail on the new urgent care benefit that provides eligible Veterans with greater choice and access to timely care in the community. 

Community Care Claims & Billing

  • If your community appointment was scheduled by TriWest and you now have a billing question, please contact:

TriWest at 1-855-722-2838

   For more information about TriWest, please see http://www.triwest.com/en/

  • If your community appointment was scheduled by the VA and you now have a billing question, please contact:

Community Care Customer Service line at 1-877-881-7618

   For more information about Community Care billing, please see https://www.va.gov/communitycare/

VA San Diego Healthcare System has a local Customer Service/Liason Team to assist Veterans and community providers when needed.  If you have questions, please call (858) 623-1879, option #3 between the hours of 7:30 a.m.-  3:30 p.m., Monday through Friday.

For general Mission Act inquiries, please contact: (866) 867-7927 or dial (858) 552-8585, option #9 or visit www.missionact.va.gov.