Addiction Treatment

Mental Health Treatment

Veteran Community Care Coverage for Mental Health & Addiction Treatment

As an enrolled veteran, your veteran community care rehab coverage through the Veteran Community Care Program may provide access to addiction and mental health treatment at approved community providers, like Banyan Treatment Centers.

This program is separate from TRICARE and applies specifically to enrolled veterans whose care needs can be met by a community provider. Call us today for a complimentary benefits verification and our admissions team will guide you through the process.

What Veteran Community Care members should know

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How Veteran Community Care Works and How It Is Different Than TRICARE

Many veterans mistakenly believe that Veteran community care is the same as TRICARE, but they are two distinctly separate programs with different goals, governance, and eligibility standards.

TRICARE is a government-run health plan that provides coverage to active-duty service members, military retirees, family members of active-duty service members, and certain former spouses.

The veteran community care program, on the other hand, is a program under the Veteran Community health care system, providing services and benefits to enrolled VA health care beneficiaries who meet one or more of the MISSION Act requirements.

In order to qualify for Veteran Community Care for mental health and substance abuse treatment resources, you must meet one or more of the MISSION Act Criteria:

You are seeking care that is not available through the Veteran Community Care
You do not have a full-service Veteran Community Care in your state
The care that you need is better provided at a local community health care setting based on the clinical judgement of your Veteran Community Care provider
The driving time to a VA facility is more than 30 minutes for primary care and more than 60 minutes for specialty care

Veterans require pre-authorization to access Veteran Community Care mental health services and substance abuse treatment through community care, with the exception of emergency situations.

After receiving prior authorization from your Veteran Community Care health care providers, the VA will directly pay for your drug and alcohol rehab at Banyan Treatment Centers.

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What Treatment Services May Be Covered by Veteran Community Care?

Veteran community care rehab coverage may cover the following levels of care:

Medical Detoxification

The critical first step in drug or alcohol recovery, medical detox ensures safety and comfort for those in withdrawal under the supervision of qualified medical professionals.

Residential / Inpatient Treatment

Around the clock, structured addiction care for those who require assistance with a substance use disorder and often co-occurring mental health conditions.

Partial Hospitalization (PHP)

Intensive daytime addiction treatment programming.

Intensive Outpatient Programs (IOP)

Organized treatment groups, held two or more days per week.

Outpatient Treatment

One-on-one therapy and group sessions, including trauma-informed, evidence-based treatments.

Medication Assisted Treatment (MAT)

Use of FDA-approved medications to treat opioid and alcohol addiction, in conjunction with counseling and peer support.

Dual Diagnosis Treatment

Simultaneous, integrated care for alcohol and drug addiction, in conjunction with post traumatic stress disorder (PTSD), depression, anxiety and other conditions.

Psychiatric Medication Management

Maintenance treatment of prescribed psychiatric medications.

Telehealth Intensive Outpatient Programs (IOP)

Veterans authorized for community care may access virtual IOP programs through Banyan's telehealth platform, including dual diagnosis, substance use, and mental health programming across multiple states.

Note: Veteran's health care prioritizes dual diagnosis treatment, because substance abuse commonly co-exists with PTSD, traumatic brain injury and other conditions related to military service.

Does Veteran Community Care Cover Mental Health Treatment?

Yes. The Veteran Community Care Program covers mental health treatment as a core part of veteran health care. VA mental health services include treatment for PTSD, depression, anxiety, traumatic brain injury, and other conditions that frequently co-occur with substance use disorders.

For veterans, dual diagnosis treatment is particularly important because substance abuse commonly co-exists with service-related conditions.

Inpatient Mental Health Coverage

Banyan offers inpatient mental health treatment at multiple locations for veterans authorized for community care. Contact Banyan's admissions team to confirm your VA authorization covers this level of care.

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How Does Veteran Community Care Pay for Treatment?

Unlike commercial insurance, the VA pays community providers directly for authorized veteran community care. Veterans typically do not pay out-of-pocket for authorized community care treatment.

How the VA Payment Process Works

The VA authorizes community care within its Community Care Network (through Optum Serve or TriWest Healthcare Alliance)
Once authorized, the VA pays Banyan directly for treatment
Duration of stay is determined by medical necessity and ongoing clinical review
Your VA provider works alongside the community provider (Banyan) and the TPA throughout treatment

What You Can Do Right Now

Call us today for a complimentary insurance verification. We are here for you every step of the way.

Questions? Get help now

If You Call Veteran Community Care Directly, Ask:

Is medical detox covered?
Are inpatient or residential programs covered under my plan?
Are PHP or intensive outpatient programs covered?
Do I need prior authorization?
Is this facility in-network?
What are my deductibles, copays, and coinsurance?
Are there limits on the number of treatment days or sessions?

Or, We Can Verify for You (Recommended)

We contact your insurance provider directly
We review coverage details and medical necessity requirements
We explain the benefits clearly and confidentially

Steps to Getting Veteran Community Care at Banyan

Get an authorization for vet community care treatment.

Contact your VA health care team for more information on qualifying for a community care referral.

Contact Banyan's admissions team to discuss treatment, and we can start the authorization process with the VA on your behalf.

Once we begin this process the VA will pay directly for community care. The VA authorizes treatment within their Community Care Network (through Optum Serve or TriWest Healthcare Alliance).

Next, complete your clinical assessment for an accurate assessment of the most appropriate level of care. The VA pays directly for authorized vet community care treatment.

How to Find Treatment That Accepts Veteran Community Care

Banyan Treatment Centers accepts veteran community care in 17 locations throughout several states. Banyan also offers a robust telehealth option, allowing veterans access to dual diagnosis rehab programming from home.

Getting Matched to the Right Level of Care

A clinical assessment helps determine the most appropriate treatment program based on substance use severity, mental health needs, and VA authorization.

Next Steps: Verify your Veteran Community Care eligibility or speak with an admissions specialist today.

Questions? Get help now

Frequently Asked Questions

1How long will Veteran Community Care pay for rehab?

The VA follows an authorized federal process for vet community care treatment, meaning a VA health care provider must authorize treatment, and the duration is based on medical necessity. The VA authorizes community care within its community network (through Optum Serve or TriWest Healthcare Alliance). The duration of your stay will be determined by the medical necessity of the care and ongoing clinical documentation submitted by your treatment team. Unlike commercial insurance, the vet community care process includes the VA provider working alongside both the community provider (Banyan) and TPA. Banyan's clinical team advocates on your behalf throughout this process.

2What is the difference between VA Community Care and TRICARE?

TRICARE is the federal health care program available to active-duty service members, military retirees, and their families. Vet community care is an additional benefit provided through the VA health care system for enrolled veterans, and is authorized within the VA under the MISSION Act. These two programs have unique eligibility requirements, networks, and authorization processes. If you are not sure whether TRICARE or Veteran community care applies to you, our admissions team can help clarify.

3Does the Veteran Community Care program cover treatment for dual diagnosis?

Yes. The Community Care Program is well aware that substance misuse often co-occurs with PTSD, trauma, depression, anxiety, and other service connected conditions. As a result, dual diagnosis treatment, the practice of treating addiction along with the co-occurring mental health conditions that accompany it, is covered at Banyan for vet community care patients. This is probably the most common reason why vets utilize the vet community care program.

4Will I have to pay out-of-pocket if I utilize the Veteran Community Care program?

Most likely not. Unlike health insurance, the VA pays for community provider care for veterans. Community providers are paid directly by the VA on behalf of their veteran patients for treatment. Once the VA approves you for community care, and sends a referral to Optum Serve (if you are in the eastern USA) or TriWest (if you are in the west USA), those companies will pay your provider directly.

5Do I need a referral from the VA for community care rehab?

Yes. VA community care requires prior authorization from your VA health care provider. A VA health care provider must determine that community care is appropriate for you based on specific criteria established by the MISSION Act. Examples of criteria to establish eligibility include drive-time standards, lack of VA services in your area, or a recommendation for community care treatment from your VA provider. In the case of emergency care, you will not need to obtain prior authorization from the VA.

Coverage varies by Veteran Community Care plan and state. Insurance verification is required to confirm eligibility and benefits.