The community care program is intended to help veterans seek care that they can’t get from the VA, whether due to difficulty reaching the VA facility or if the VA facility’s program is full or not available to the veteran. If this happens, the veteran would then start the process of seeking care from an approved community care provider. For example, American Addiction Centers (AAC) is considered to be one of those approved VA preferred providers. If a veteran is unable to obtain substance abuse treatment at a VA facility, they can be approved by the VA to attend treatment at an AAC facility.
The process for veterans seeking care is simple:7
Contact the VA for approval to seek care from a community care program provider. They will determine eligibility.
Once authorized, the veteran can either search for a preferred VA provider themselves or with help from VA staff.
The Veteran schedules the appointment and notifies the VA of the upcoming appointment.
The VA sends a referral to the veteran and to the provider.
The veteran receives care at their scheduled appointment.
The VA preferred provider sends a claim to the TPA for payment from the VA.
It’s important to realize that, despite the ability to receive care from the VA, it’s also beneficial to have private health insurance. Private insurance does not affect eligibility for VA care. Instead, it simply supplements any non-service-related care a veteran may receive. If a veteran does receive care that isn’t covered by the VA, the VA can then bill the private health insurance, whether it’s their own policy or a spouse’s policy under which they’re covered.8 If you are eligible for Medicare or Medicaid, you may be able to use these to help cover the costs of treatment associated with Community Care partners. However, whether or not you can use Medicare or Medicaid depends on whether or not the facility you are attending accepts those insurances. It’s important to communicate with the VA and the Community Care facility you’re thinking about attending to determine the extent of your coverage.