What If the Provider You Need Isn't in VA's Community Care Network?

What if the provider I want isn't in the network?

Ask your VA team. VA's referral page says to contact your VA health care team if the provider you want isn't in the network, or if you can't find an in-network provider who meets your needs.

The options:

1. The provider joins the network. They contract with the administrator for their region, Optum or TriWest. This can take time.
2. VA uses a Veterans Care Agreement (VCA). A direct agreement between VA and that provider. See below.
3. VA finds a different network provider who can meet your needs.

When can VA use a Veterans Care Agreement?

Under 38 CFR 17.4115, when VA decides the care isn't feasibly available through a VA facility, a contract like the network, or a sharing agreement. VA can base that on:

• your medical condition;
• the travel involved;
• the nature of the care; or
• a combination of these.

VA's VCA page says VCAs are used in limited situations when network services are unavailable or inadequate. See What Is a Veterans Care Agreement?

What if there's no network provider who can meet my needs?

The provider VA uses still has to be accessible to you. Under 38 CFR 17.4030(c), an eligible provider has to be accessible to you, based on wait time, qualifications, and distance. A network provider who's three hours away or booked for four months may not meet that.

Common situations:

• No in-network therapist nearby who treats your condition, like a trauma specialty or eating disorders.
• The only in-network specialists aren't taking new patients.
• You need a provider who speaks your language or has specific training.

Tell VA exactly what you need and why the network options don't work. Put it in writing.

How do I ask?

Send a Secure Message to your VA team or Community Care office. Include:

• the care you need;
• the network providers you tried and why they didn't work, like their wait times, distance, or not accepting new patients;
• the provider you want, with their name, phone, and whether they'd consider a VA agreement; and
• a request for VA to find an accessible provider or consider a Veterans Care Agreement.

What should I tell the provider I want?

That VA has two ways to work with them: joining the Community Care Network through their region's administrator, or a direct Veterans Care Agreement with the local VA medical center if VA decides one is needed. VA can't pay them for routine care without one of these.

What if VA won't help?

Ask for the decision and reason in writing. If you're being denied Community Care altogether, you can appeal through VA's clinical appeals process. See Appealing a Community Care Denial. For a stalled request, see What to Do If Your Referral Is Delayed or Stuck.