The short answer
Routine Community Care needs VA's approval before the visit. VA urgent care doesn't: eligible Veterans can walk into an in-network urgent care clinic. Emergency care never needs approval first, but VA should be told within 72 hours. Emergency suicide crisis care under the COMPACT Act is free and doesn't require VA enrollment.
Which kind of outside care is this?
VA pays for outside care through four different paths, and each has its own rules. The one that applies depends on how urgent the problem is.
| Routine Community Care | Urgent care | Emergency care | Suicide crisis care | |
|---|---|---|---|---|
| Approval before the visit | Yes | No | No | No |
| Where | Approved community provider | In-network urgent care or retail clinic | Nearest emergency room | Any emergency room, VA or not |
| Enrollment needed | Yes, or a covered exception | Yes, plus VA care in past 24 months | Depends on the claim type | No |
| What you pay at the visit | $0 | $0 | Depends on eligibility | $0 |
| Main rule | 38 CFR 17.4020 | 38 CFR 17.4600 | 17.4020(c), 38 U.S.C. 1725 and 1728 | 38 CFR 17.1200-17.1230 |
Routine Community Care
This is planned care: a specialist, therapy, a test, or surgery. You need to qualify under one of VA's eligibility rules, and VA has to approve the care and send a referral before your appointment. If you go first and ask later, VA generally won't pay.
Use it when the care can wait for VA to arrange it. See How to Get a Community Care Referral.
Urgent care
Urgent care is for minor illnesses and injuries that need attention soon but aren't emergencies: strep throat, pink eye, a sprain, an ear infection. Under 38 CFR 17.4600, eligible Veterans can go without a referral to an urgent care or walk-in retail clinic in VA's network.
Key rules:
- You must be enrolled and have had VA or VA-approved care in the past 24 months.
- The clinic must be in VA's network. VA can't pay out-of-network urgent care.
- You tell the clinic you're using your VA urgent care benefit.
- It covers single visits only. Follow-up goes through your VA team.
- Priority Groups 1 to 5 get three free visits a year, then pay $30 a visit.
Full details are in VA Community Urgent Care.
Emergency care
If you think your life or health is in danger, call 911 or go to the nearest emergency room. You never need VA's approval first.
After the emergency starts, VA should be notified within 72 hours. The hospital usually does this, but you or someone helping you can too. VA's emergency notification line is 844-724-7842, or providers can use VA's online emergency care reporting portal. When VA gets timely notice and approves the care, it's handled as authorized Community Care under 38 CFR 17.4020(c).
If VA isn't notified in time, the claim isn't automatically denied. It's reviewed under separate rules for emergency care VA didn't authorize, in 38 U.S.C. 1725 and 1728. See Non-VA Emergency Care.
Emergency suicide crisis care
If you're in a suicidal crisis, VA covers emergency care at any VA or non-VA facility at no cost to you. This comes from the COMPACT Act and is in 38 CFR 17.1200 through 17.1230. You don't need to be enrolled. VA can cover up to 30 days of inpatient or crisis residential care, or up to 90 days of outpatient care, plus ambulance costs.
If you need help right now, call 988 and press 1, or text 838255. See Free Emergency Suicide Crisis Care.
How do I pick the right one?
- Can it wait for an appointment? Routine Community Care or VA.
- Needs care today but isn't life-threatening? In-network urgent care, or same-day care at your VA.
- Could it be life-threatening? The emergency room. Notify VA within 72 hours.
- Thinking about suicide or in crisis? Call 988 and press 1, or go to any emergency room.
When you aren't sure, choose the safer option. VA's rules shouldn't keep you from emergency care.