Urgent Care vs. Emergency Care.
We often live by the "Seven P's": Prior Proper Planning Prevents Potential Poor Performances. However, we sometimes encounter an event that we didn't plan for or anticipate, such as an unexpected medical issue.
Though there are many questions racing through your mind at that time, the question of where you can get immediate treatment for a condition will hopefully be answered by this article.
When a sudden illness or injury takes place, the first question that needs to be answered is whether this is an urgent care need or an emergency care need.
According to the Veteran Health News of the VA (Department of Veterans Affairs) San Diego Healthcare System, urgent care is medical services "provided for illnesses or injuries which require prompt attention but are not life-threatening."
Examples of these are coming down with the flu, getting pinkeye or getting strep throat.
On the other hand, emergency care is considered "inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health."
Examples of these are moderate to severe burns; heavy, uncontrollable bleeding; seizures and/or loss of awareness; or severe chest pain.
If you do happen to experience a medical emergency requiring immediate assistance, call 911 right away.
Under the VA Mission Act of 2018 for the community care program (formerly known as the Veterans Choice program), urgent care is now covered for eligible veterans.
Under this new program, all veterans who are enrolled in the VA health care system and have received care through the VA within the past 24 months are considered eligible veterans. Veterans seeking care at an urgent care provider within the VA's network can receive such care without prior authorization from the VA.
To find an urgent care provider near you, visit VA.gov/find-locations, vaurgentcarelocator.triwest.com or call 866-620-2071.
Urgent & Retail
Under the urgent care network, there are two types of urgent care: urgent and retail.
Urgent locations provide more comprehensive care for illnesses or injuries such as wound treatment, lacerations, casting and splinting, while retail locations are places like CVS or Walgreens where you can receive care for minor ailments such as an earache or sore throat.
The VA is currently working on expanding its network of providers. These providers are vetted by the VA and must meet strict standards of care requirements before they are added to the VA network.
In addition, you can fill prescription medications from one of these urgent care facilities. It's possible to get up to a 14-day supply of a prescription medication, even if it's a noncontracted pharmacy.
In this case, you'll be required to pay for the prescription on your own and then file a claim for reimbursement at your local VA medical facility. Any prescription longer than a 14-day supply must be filled by a VA pharmacy.
Regarding copayments for urgent care needs, these are based on your assigned VA priority group and the number of times you visit such facilities during the calendar year.
Unlike most facilities, urgent care copayments aren't charged when you receive the care from the facility you go to but will be billed separately by the VA.
Which priority group are you in?
* If you have a VA rating greater than 50% or were awarded the Medal of Honor, you're in priority group 1. Priority group 1 members don't pay copayments at a VA facility.
* If you have a VA service-connected disability rating between 30% and 40%, you're in priority group 2.
* VA service-connected disability ratings of 10% to 20% or veterans who are former prisoners of war, were awarded a Purple Heart or those receiving 1151 benefits for being disabled by treatment or vocational rehabilitation are in priority group 3.
* Veterans who are determined by the VA to be catastrophically disabled are considered priority group 4 and also don't pay copays at a VA facility.
In most cases, copayments for urgent care are different from other VA medical copayments. For the above priority groups, there are no copayments for the first three visits during a calendar year. A fourth visit or more, you are charged $30 each time.
With this expansion you can either continue to receive care at a VA facility or go to a qualifying local clinic for urgent care needs.
If you believe that you're in an emergency, go to the hospital as quickly as possible. Inform the hospital that you're a veteran and are required to go to a VA hospital as soon as you are medically stable for transfer.
For more information, contact your local Paralyzed Veterans of America (PVA) national service officer (NSO) from the roster on page 43.
A Marine Corps veteran, Robert Kamei started working for PVA in 2009 and is a senior NSO in San Diego.
ROBERT KAMEI, SENIOR NSO