Guide to Benefits in the VA Community Care Network
Also known as the CCN, the VA Community Care Network is the link between the VA and community care providers. Through CCN, veterans can be provided with quality health care and services. The Community Care Network uses the standard requirements and guidelines to administer, pay for, and manage community providers’ services and networks. Dr. Paul’s By The Sea is a proud member of the Community Care Network. We can provide you the help you need with the support of the VA. Continue reading to find out what steps you can take to utilize your benefits through CCN.
Step 1: Find Out if Your Eligible for Benefits
Veterans’ health care or specific needs could determine their eligibility to receive care from their community provider. Even if they meet the particular eligibility requirements for a community provider, they will still have the option of getting help at a VA medical facility. Before a veteran can get care from a community provider, they must first receive the VA’s approval if they do not want to be billed for the care they received. A veteran must also be deemed eligible by a staff member from the VA to use a community care provider.
To determine eligibility for community care is dependent on the veteran’s individual needs or circumstances. Things to know about eligibility include:
- Getting approval from the VA to use a community care provider before receiving care said community care provider.
- The veteran must either be enrolled or eligible for the VA’s health care benefits.
- The veteran must understand that eligibility for continual community care is dependent on the individual needs and circumstances of the veteran.
- The staff members from the VA determine the eligibility of the veteran.
Veterans will be able to qualify for community care services if they meet ONE of the following criteria.
- The person needs a service that is not provided by or available at a VA medical treatment center.
- The veteran must either be enrolled or eligible for the VA’s health care benefits.
- If the veteran lives in a State or territory of the United States that does not have a VA medical facility.
- The veteran falls under the “Grandfather” provision regarding the distance eligibility for VCP.
- The VA is unable to provide the care the veteran needs within the designated access standards.
- The community care provider is what’s best for the veterans’ medical care.
- The Service Line provided by the VA is unable to meet quality standards.
Step 2: Making an Appointment
Veterans who decide they want to use a community care provider must first meet with a VA staff member to discuss their preference for a community provider. The staff member can then determine the eligibility of the veteran.
Once eligibility has been determined, the veteran will choose their preferred community provider or have a staff member from the VA to select one. However, whichever provider is selected must be a part of the community care network. For the veteran to use their desired community provider, they must be referred there from the VA. The VA is also required to send all medical documentation.
To schedule an appointment with the selected provider, the veteran can choose to:
- Schedule the appointment themselves and then inform the VA about the appointment.
- Use the VA’s online scheduling system to request the appointment.
- Request that a VA staff member schedules an appointment.
- Use the VA’s Third Party Administrator (TPA) to schedule appointments.
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Step 3: Receiving Care
Once the veteran arrives at the community care provider for their appointment, the provider should already have the following information:
Step 4: Billing & Payment
While the veteran’s VA benefits will cover the veteran’s care, the veteran may still be responsible for paying a copayment. This is to cover the nonservice-connected care, which the veteran would have been required to pay for even if they used a VA medical facility. If the veteran had to enter urgent care, the copayment would be determined by the assigned priority group and how often the veteran visited urgent care in one calendar year.
Community providers cannot receive copayment from veterans; this includes urgent care. The VA handles all billing for veterans. The VA may also bill an insurance company for care a veteran received that was non-service connected.
Joint Commission Accredited
Dr. Paul By The Sea is fully credentialed and licensed in the state of Florida by the Joint Commission for the Accreditation of Healthcare Organization (JCAHO). JCAHO is unanimously considered the gold standard of addiction treatment by industry professionals. Knowing that the facility has obtained this certification should be a top priority for individuals to look at when researching to find the right inpatient or outpatient treatment facility for them.
We dedicate our facilities and treatment methods to ensuring that we provide the best available recovery options while maintaining professional levels of care. Please contact us today and hear how our caring staff of experts use their experience to implement evidence-based treatments to make sure each of our patients receives the most effective treatment regimens.
Getting Treatment At Dr. Paul’s By The Sea
Our St. Augustine addiction treatment center is proud to provide services to our military veterans. Dr. Paul’s By The Sea is an approved community care provider and helps veterans overcome their struggles with substance use disorders and mental health disorders. Contact your local VA today and find out if you are eligible for our treatment program.
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