A Step-by-Step Guide for Veterans and Family Caregivers

Provided by Veterans Desk, Inc. – Supporting Veterans Through Every Step

🔹 Step 1: The VA approves the Referral

• The VA will issue an authorization for your care outside the VA system (usually on Form 10-10172). 
• This referral may be triggered by: 
  • Long wait times 
  • Distance to a VA facility 
  • Lack of specialist availability 
  • Clinical necessity 

Keep a copy of your referral and authorization number.

🔹 Step 2: Scheduling the Appointment

• The VA or a Third Party Administrator (TPA) (Optum or TriWest, depending on your region) will help schedule the appointment with the community care provider. 
• You may also be allowed to contact the provider directly, but only after authorization is confirmed. 

✅ Important: Never attend an appointment without confirming that the provider has received VA authorization.

🔹 Step 3: Attend the Appointment

• Go to your scheduled appointment and receive care as authorized. 
• You do not need to present any insurance. 
• You do not pay a co-pay or out-of-pocket cost for authorized care. 

🔹 Step 4: The Provider Bills the VA – Not You

• The community provider must submit their bill to the correct TPA (TriWest or Optum) or directly to the VA. 
• The provider is not allowed to send you a bill for authorized services. 
• The VA makes payment once documentation is reviewed and approved. 

🔹 Step 5: Keep Records

Keep a personal folder with:

• Your VA authorization letter/form 
• The provider’s appointment summary or “After Visit Summary” is a document that outlines the care you received, any medications prescribed, and any follow-up instructions. This is a vital record to keep for your health management and any potential disputes. 
• Any bills you mistakenly receive (do not pay them) 
• Any communication with the VA or provider 

🔹 Step 6: What If You Receive a Bill?

Do not pay. Do not ignore it. Take these steps:

1. Contact the Provider’s Billing Office: 
   • Inform them that the care was VA-authorized and that you are not responsible. 
   • Give them the authorization number and date of service. 
   • Request that they submit the bill to the VA or resubmit if previously denied. 
2. Call the VA Community Care Office: 
   • Use the phone number listed in your referral paperwork. 
   • Ask for help resolving the billing error. 
3. Call the TPA (TriWest or Optum): 
   • Provide your authorization number and date of service. 
   • Ask for claim status and clarification. 
4. Veterans Desk: 
   • Visit VeteransDesk.org word template examples to avoid collections
   • These templates are for educational purposes only.

• This should not happen. 
• You have rights under the VA MISSION Act to dispute medical debt caused by VA billing delays. 

Take action:

• Contact the collections agency and explain this is VA-authorized care. 
• Request a pause on collections while you resolve the issue with the VA. 
• If you’re having trouble resolving a billing issue, you can file a formal complaint with the VA Office of Community Care. This office is responsible for overseeing the Community Care program and can help you resolve disputes. File a formal complaint with the VA Office of Community Care. 

Veterans Desk is here to help with step-by-step templates and outreach support, providing you with the reassurance and support you need during this process. You are not alone in this journey.

🔹 Step 8: Help the VA Pay the Provider (if needed)

In some cases, a claim is denied because:

• The provider used the wrong billing code 
• The claim was submitted late. 
• There was a missing progress note.e 

While it’s not your job to fix this, you can:

• Provide your referral and date of service 
• Your VA Community Care Coordinator can help the provider resubmit the claim if needed. They are there to assist you throughout the process, from the initial referral to the final payment. Ask your VA Community Care Coordinator to help the provider resubmit. 
• Ask Veterans Desk for sample letters to help move the claim forward.d 

🧾 How the Provider Gets Paid

1. Provider receives VA authorization. 
2. Provider sees the veteran and documents the care. 
3. Provider submits claim to TriWest or Optum with: 
   • Correct VA authorization number 
   • CPT/diagnosis codes 
   • Progress notes 
4. TPA/VA reviews and approves payment. 
5. The VA pays the provider—not the veteran. 

⛔ If the provider skips a step or files late, they may be denied—but still cannot bill you.

💬 Summary

• Veterans never pay for VA-authorized Community Care. 
• Always keep your authorization number and appointment records. This will help you stay organized and in control of your care. 
• Never ignore a bill—respond, dispute, and reach out for help. 
• Use VeteransDesk.org to download templates, track your case, and protect your credit.