VA-paid care from your own doctor — when VA can't see you fast enough.
1. What Is Community Care?
Community Care is VA-authorized, VA-paid medical care from private (community) providers outside the VA system. You see a doctor of your choice. VA pays them directly. This is NOT TRICARE.
💡 Community Care is a VA benefit you've earned — not a special favor. Advocate for yourself if you qualify.
2. When You Qualify
You need to meet any one of six standards — not all of them:
- VA doesn't offer the service you need at any VA facility.
- You live in a state or territory without a full-service VA facility.
- You qualified under the old 40-mile distance rule as of June 6, 2018, in Alaska, Montana, North Dakota, South Dakota, or Wyoming.
- You and your VA provider agree that community care is in your best medical interest.
- VA can't provide the service to its own quality standards.
- VA can't meet its drive/wait time standards: 30 minutes or 20 business days for primary care and mental health; 60 minutes or 28 days for specialty care.
You also need to be enrolled in VA health care (or eligible without needing to enroll), and have prior approval except in urgent or emergency situations.
💡 Track your wait times. If VA offers an appointment more than 20 business days out for primary/mental health, or 28 days for specialty care, you have grounds for Community Care.
3. How to Request It
Call your VA facility or ask your VA primary care team. Use this exact phrase:
"I am requesting Community Care due to access standards not being met."
VA is required to consider your request. You can also call the Community Care line directly.
VA Community Care866-606-8198 · M–F 8am–6pm ET
4. Authorization — Critical Step
Wait for VA to send your authorization before seeing any community provider. VA sends authorization directly to the provider and to you.
⚠️ Do NOT see a community provider without prior authorization. VA will not pay the bill. You will be responsible for the cost.
💡 Keep your authorization number somewhere accessible. You'll need it if there's ever a billing dispute.
5. Finding a Provider
Use VA's Community Care Provider Locator at va.gov/COMMUNITYCARE/providers.asp or call the Community Care line. TriWest (western US) and Optum (eastern US) manage the networks.
💡 Your preferred doctor may already be in the network. Check before assuming they're not.
TriWest (Western States)844-455-2200
6. If You Get Billed
If a community provider bills you for authorized care, call VA immediately. Use this phrase:
"I am disputing this bill. I had prior authorization. My authorization number is [X]."
⚠️ Do not pay the bill first and try to get reimbursed later. Dispute it before paying.
Community Care — Billing Disputes866-606-8198