Consumer Protection for Veterans Seeking Community Care
Community care for the Department of Veterans Affairs (VA) ensures that Veterans receive the care they need by expanding the care network beyond the VA medical system. Access to community care depends on eligibility requirements, the availability of VA care, and the specific needs of individual Veterans.
All Veterans (regardless of whether they are enrolled at the VA or not) can receive emergency suicide care when and where they need it as a result of the Veterans Comprehensive Prevention, Access to Care, and Treatment Act (. For VA community care outside of an emergency suicide situation, it is crucial for Veterans to take the necessary steps to confirm their and to identify qualified, trustworthy providers.
There are many ways to help you find the right provider, avoid predatory practices from insurers and healthcare systems, and protect your personal and financial information while seeking community care.
How to identify qualified and trustworthy providers
Finding the right medical provider isn’t always as easy as it appears. For Veterans seeking community care, this process may feel daunting and is often filled with questions and uncertainties. When searching for the right community care provider, Veterans should consider the following aspects:
Understand provider expertise and experience.
Depending on the type of medical or health issue you are seeking care for, you may need a provider with a specialty or specific expertise. Identifying the common terms and language related to that expertise can help you search for and find doctors who possess the right knowledge and tools to deliver excellent care. Educational credentials, board certifications, and certificates or specialized training programs can assist you in identifying a provider who is well-educated and properly credentialed for the treatment you may require. You can usually find this information through online resources, such as insurance or hospital websites, or by asking the doctor or their medical practice for this information.
Assess accessibility and network coverage.
Identifying in-network providers for community care is crucial. You can look for in-network providers on the VA website https://www.va.gov/find-locations or ask your VA health care team for assistance in finding a suitable provider. If you’re unable to locate an in-network community provider that meets your needs, or the one you prefer is outside of the network, the VA recommends discussing this with your VA health care team, as further authorizations may be necessary. Additionally, it’s essential to confirm that the provider is located where you can access them or offers telehealth options suitable for your care needs.
Focus on communication and patient care.
Finding the right medical provider means selecting someone you trust and feel safe and comfortable with. While it can be challenging to gauge this before starting to work with a provider, there are signs to watch for before and during your visit. You should anticipate clear communication from both the medical provider and their staff. Clear communication involves explaining things in a way you can understand, ensuring you leave feeling more informed rather than confused or uncertain. This clarity applies to your medical care and financial matters such as cost-sharing or co-pays. Providers and their office staff should always treat you and your family members with dignity and respect. You should expect your provider to listen and take your concerns seriously.
If you’re having trouble finding a qualified and trustworthy provider for community care, talk to your VA health care team or your VA patient advocate. A patient advocate can assist you if you’re not receiving the care you need, if you’ve had difficulty resolving issues with a provider, or if you feel you need someone to serve as a resource. The VA encourages reporting Veteran complaints about in-network community care providers to ensure that those entrusted with caring for Veterans uphold VA standards. Complaints may include concerns such as discrimination, rude staff, office issues, or long wait times and should be reported to your patient advocate. To make a report, contact your VA medical center and ask for the patient advocate. Additionally, you can call the VA at 877-881-7618 (TTY: 711); this phone line operates Monday through Friday from 8:00am to 9:00pm Eastern Time.
Avoiding predatory practices by medical providers and insurers
In healthcare, as in other areas of life, there are individuals and organizations that may attempt to take advantage of those with medical coverage and benefits. Veterans seeking community care may be viewed as targets due to their connection to the VA medical system, so it’s important to stay vigilant and equip yourself with prevention strategies.
Medical providers outside the VA medical system may attempt to submit claims and receive payment for services they never provided to you.
Prevention tip: Check all your paperwork to verify the dates of service for the care received, the types of services, and to ensure accurate patient information (name, date of birth, location).
Providers who recommend unnecessary treatments or procedures (e.g., up-selling) exploit your healthcare from the VA.
Prevention tip: Discuss treatment and procedure options thoroughly with your doctor to ensure you understand what is being proposed and why. If you have questions, reach out to your VA health care team or consider seeking a second opinion.
Blank or incomplete forms that a medical provider or their office staff asks you to sign.
Prevention tip: Review all forms and documents you are asked to sign to ensure you understand their purpose and whether they contain incomplete or mission-related information. Make sure all your information is correct on the forms. If you do not understand something on a form, ask until you receive a clear answer.
Direct contacts from the VA can be surprising, especially if you weren’t expecting to be reached out to. Professional scammers employ tactics like official-looking logos, seals, and email addresses to attempt to gain access to benefits and sensitive information.
Prevention tip: Confirm legitimacy by only calling official VA numbers or by asking for more documentation or verification of their status.
For more tips on spotting and avoiding predatory behaviors and fraud, you can visit the VA’s Fraud Prevention Kit. If you believe you have encountered healthcare-related fraud, you can reach out to your patient advocate or contact the Veterans Health Administration Office of Integrity and Compliance Helpline at 866-842-4357 (VHA-HELP).
Tips to safeguard your personal, medical, and financial information
Whether you’re seeking VA community care or just going about your day-to-day life, it’s important to stay vigilant in protecting your personal, medical, and financial information. Scammers and phishing schemes are increasingly complex in their methods and means of committing fraud, so consumers and patients must remain ready and aware.
Here are some useful tips to assist you as a Veteran or to support others you may know:
Do not share your personal, medical, or financial information in response to an unexpected call, email, or text message, even if they provide personal details about you. Legitimate organizations and companies will never ask for sensitive information such as your Social Security number, bank account, medical ID numbers, or credit card information via email, text, or phone call.
Resist the urge to act immediately if someone pressures you to do something right away. Scammers often manipulate you into acting without delay by threatening negative consequences if you don’t respond quickly, such as pretending to take legal action against you or claiming you’ll miss out on money or benefits available to you if you don’t act now. Legitimate businesses give you time to decide and specify deadlines for when things need to be completed.
Before taking any action, including disclosing your personal information, talk with someone you trust. If you receive a request or have an interaction that you’re uncertain about, reach out to a friend, family member, or co-worker who you trust to discuss it. This can create distance between you and the request, allowing time to think through your options and spot potential red flags. If you get an email you suspect is a scam, do not reply until you can confirm that the email is legitimate.
Always contact a company or organization using publicly available information like their phone number, email address, or web portals. If you’re unsure, reach out to the organization, company, or institution through the information found on their official website. For instance, if someone from your bank contacts you, you can hang up or call them back using the official phone number listed on their website or in your mobile app.
For more information on how to protect your personal, medical, and financial information, you can access the VA’s Fraud Prevention Kit, which is a free PDF resource filled with tips and information. There are VA and government resources available if you believe you have been a victim of fraudulent activity or a scam:
