The short answer
For care VA authorized, the provider bills VA or the network administrator, not you. They shouldn't collect a copay at the visit, bill you for the difference between their charge and what VA paid, or charge you a missed-appointment fee. VA bills any copay you owe separately. The main exception is care outside your authorization that VA didn't approve.
What can a Community Care provider charge me?
For authorized care, nothing directly. The provider bills VA or VA's network administrator (Optum or TriWest), and VA pays the provider. Any copay you owe comes from VA, later, under 38 CFR 17.108(c)(4). See Copays for Community Care.
Can a provider collect a copay at the visit?
No. Your Community Care copay is $0 at the time of service. VA's provider guidance on urgent care says the same: providers shouldn't collect a copay because VA bills and collects copays separately. If a front desk asks for one, show them your authorization and say VA bills copays directly.
Can a provider balance bill me?
No, for authorized care. Balance billing means billing you for the difference between the provider's charge and what VA paid.
- Veterans Care Agreement providers: VA's VCA page says they may not bill the Veteran or the Veteran's other insurance for authorized care.
- CCN providers: The network contracts, and the provider manuals Optum and TriWest publish for VA's network, say VA's payment is payment in full for authorized services and Veterans aren't billed for them.
- Urgent care: Under 38 CFR 17.4600(f), VA's payment ends your responsibility to the provider.
- Emergency suicide crisis care: Under 38 CFR 17.1225, VA's payment ends your responsibility too.
Can a provider charge a no-show fee?
The CCN provider manuals say participating providers may not charge Veterans for missed appointments. A practice's normal civilian no-show policy doesn't apply to your authorized VA visit. Still, cancel as early as you can. Repeated no-shows can affect whether a provider keeps seeing you.
What if the provider's claim was denied?
A denied claim doesn't automatically become your bill. VA's provider claims page separates two outcomes:
- Rejected: VA needs more information before paying. The provider can fix it and resubmit.
- Denied: Usually because the care wasn't authorized and doesn't qualify as emergency care.
If the care was inside your authorization, the provider has its own correction and dispute routes with VA or the administrator. See Provider Claim Disputes vs. Veteran Appeals.
When could I actually owe the provider?
When the care wasn't authorized. For example:
- you saw the provider before VA approved the referral;
- you went after the authorization ended;
- you got a service your authorization didn't include, and VA didn't approve it through a Request for Service; or
- you agreed in writing to pay for something VA doesn't cover.
That's why it helps to check your authorization letter before each visit.
How does VA pay providers?
At rates set in the CCN contracts or the Veterans Care Agreement. Under 38 CFR 17.4035, VA's rates generally can't exceed Medicare rates, with exceptions for highly rural areas (counties with fewer than seven people per square mile), for situations where VA finds Medicare rates aren't practical, and for Alaska, which uses its own fee schedule.
What should I do if I get a bill?
- Don't ignore it, and don't pay it yet.
- Call the provider's billing office and give them your authorization number. Ask them to bill VA or the network administrator.
- A polite script: "This visit was authorized through VA Community Care, authorization number ___. VA's rules say authorized care is billed to VA, not to me. Can you check the authorization and resubmit the claim?"
- If that doesn't fix it, call VA's Community Care contact center at 877-881-7618.
More detail: What to Do If You Get a Bill for Authorized Community Care.