Medical Enrollment and Eligibility
The Veteran and the VA Health Care System
This fact sheet has been prepared by the Ward County Veterans Service Officer to help veterans who are eligible and enrolled in the Department of Veterans Affairs (VA) health care system to better understand how the system works. This is not an official VA publication and the information contained comes from a variety of sources and experience. This information is correct to the best of my knowledge and current as of 1 March 2010.
To be eligible for VA health care at a VA facility, the veteran must first enroll. This can be accomplished at the County Veterans Service Office by completing a VA Form 10-10EZ. The veteran must have a copy of his/her separation papers/DD 214 when applying. The completed application will be forwarded to the Fargo VA Medical Center (VAMC) for processing. Processing time can vary from two to four weeks. The veteran should get a letter from the Fargo VAMC that will let him/her know he/she is enrolled and his category of eligibility. At that time, the veteran can make an appointment with the Fargo VAMC at 800-410-8723 or the VA clinic (CBOC) at Minot Air Force Base at 701-727-9800. If you have not gotten a letter within 30 days of application, call the CBOC to see if you are in the system and can make an appointment. Expect a two to four week wait to get your first appointment at Minot AFB.
Veterans enrolled in the VA medical system will be either category A or C. Income, assets, and medical expenses of the veteran and his dependents determine category. Low- income (less that $11,830/year) veterans are not charged for medical care or medications. All other veterans receiving medications from the VA will be charged $8 per month per medication. Veterans in Category C (higher income/assets) will be charged a $15.00 office call charge for each outpatient visit to the VA clinic or hospital. If specialty outpatient care is needed, that charge is $50.00. If a veteran has private insurance, VA will bill the insurance company. The vet will be responsible for any charges insurance does not cover, but will not pay more than $50.00 I will not go into detail on income/asset criteria because it is complicated and changes periodically. That information will be covered during the enrollment process. All prices are subject to change.
Once in the system, he/she must make an appointment with the VA medical facility for a "new patient" appointment. When the vet goes to his appointment, he must take his prescriptions and a brief medical history or medical records (from the last 6-12 months) with him. He/she must also agree to be followed by a VA physician concerning his/her medical treatment. Failure to do so can result in refusal of VA medical care. He/she probably should still keep his primary civilian physician and maintain private medical insurance.
To receive medications from the VA, the prescription must be written by a VA physician. Except in special circumstances, the VA will not honor prescriptions from a private doctor. All medications will be mailed from a VA pharmacy. There is no VA pharmacy at Minot AFB A refill slip will come with the medications, which should be returned about three weeks prior to running out, and another supply will be sent. The veteran can also call 1-800-661-0827 to request a refill. If a renewal or new medication is required, the veteran must again see his/her VA physician. The VA has a formulary of drugs, and may not stock the medication a private doctor has prescribed. In that case, the pharmacy will contact the doctor to see if there is a suitable substitute. If there is no substitute, or the doctor will not agree to a substitute, the VA will not provide the medication.
A veteran should not depend on the VA for complete medical care in the Minot area. The clinic provides primary care only. Any specialty care will have to be referred to the Fargo VAMC. Only the Fargo VAMC provides emergency medical care. If the veteran needs emergency care or gets other medical treatment at a private medical facility, DO NOT expect the VA to pay for it, because in most cases they will not. If a veteran is experiencing a medical problem that may require emergency care, and calls the VA clinic, clinic personnel may tell him to go to the local emergency room for treatment. That does not mean the VA will pay for the treatment. In very rare cases, VA may pay for some medical procedures, but only after prior agreement between the requesting doctor and a VA approving official. VA will not pay any bill presented without prior approval.
The VA medical providers give excellent medical care. Problems do arise because of limited facilities and staff. There may be long waiting times for primary care at the Minot AFB CBOC or for specialty care at the Fargo VAMC. The whole system may seem complicated to the new user. Kathy and I are here to assist as much as possible to make your access to VA health care as painless as possible. However, once the veteran is enrolled and is being seen at the Minot/Fargo medical facilities, we no longer have any control or input into your dealings with the doctors or pharmacy. Any problems need to be resolved with the attending physician or VA pharmacy by the veteran.
Complaints or problems should be directed to Victor Martinez, Patient Representative, at 1-800-410-9723, ext 3738.
Dale E. Braun
Ward County Veteran Services
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