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Under fee basis care (purchased care for veterans), VA may authorize a veteran to obtain medical care in the community when VA cannot provide all of the necessary medical care and services. Veterans seeking health care at VA expense should do so through a VA health care facility. The use of community care is not considered a permanent solution for veteran health care needs and is only authorized for those veterans who meet the eligibility requirements. Here are some important guidelines to follow:
Pre-authorization is required for both inpatient and outpatient care in the community. All services must be pre-authorized before a veteran receives treatment.
Consider choosing a health care provider willing to work with VA with regard to fees charged for services.
In an emergency, if it is not possible to go to a VA medical center, veterans should go to the nearest hospital emergency room or call 911. If the admission is an emergency, pre-approval is not necessary, but someone must call the closest VA medical center’s patient transfer or patient administration representative within 72 hours of the emergency or admission. There is never a guarantee of payment for emergency admissions at community hospitals.
Submit all claims for services received in the community as quickly as possible.
The fee basis program only works on the veteran’s behalf when the guidelines are followed. It is also important to remember that the eligibility status for fee basis care varies for each veteran. For additional information about fee basis care, please visit www.nonvacare.va.gov, or contact the VA Maryland Health Care System’s fee basis patient benefits counselors at1-800-949-1003, ext. 6980.