General Information – English Medical Advice: Call 1.866.682.9492 (toll-free) to speak with an “Advice Nurse.” Advice Nurses are available 24 hours a day, seven (7) days a week. They can give you medical advice and direct you to the care you need. Language Services: Call VHP Member Services at 1.888.421.8444 (toll-free) if you would like to talk to us in your language about any questions, comments or concerns. VHP in coordination with Plan Providers offers over-the-telephone language assistance at no cost to you. You can also get an interpreter to talk to your doctor by contacting VHP Member Services. In addition, as required by the Department of Managed Health Care (DMHC), VHP can provide written translation of vital documents, such as applications, Grievance or consent forms, or other important membership materials. If you have questions about language services, call our Member Services Department.
Member Grievances At Valley Health Plan (VHP) we take pride in being a member-focused health plan. Our Member Services Representatives are able to help you in resolving your concerns by calling 1.888.421.8444 (toll-free), Monday through Friday between 9:00am - 5:00pm. You may request that a Grievance be filed on your behalf or you can complete a Grievance form and submit it to VHP. Grievance forms are available through VHP and at your provider’s office. Forms are available in English, Spanish, or Vietnamese. You also have the right to request this vital document to be translated in the language of your choice; the Plan has 21 days to translate the Grievance form for you. Send your Grievance to Valley Health Plan, Attention: Grievances, 2480 N. First Street, Suite 200, San Jose, CA 95131. Alternatively, you may also submit your Grievance online in English, Spanish, or Vietnamese at www.valleyhealthplan.org. You have 180 days from the date of the event, which caused a Grievance, to file your Grievance. As needed, the 180 days starts on the date the Plan provides you with a Grievance form, translated into the language of your choice other than English, Spanish or Vietnamese.
Department Of Managed Health Care (DMHC) Consumer Help-Line The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a Grievance against your health plan, you should first telephone your health plan at 1.888.421.8444 (toll-free) and use your health plan’s grievance process before contacting the Department (for the hearing and speech impaired, call the California Relay Service (CRS) by simply dialing 711 or the 800 CRS number of your modality). Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a Grievance involving an emergency, a Grievance that has not been satisfactorily resolved by your health plan, or a Grievance that has remained unresolved for more than 30 days, you may call the Department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The Department also has a toll-free telephone number (1.888.HMO.2219) and a TDD line (1.877.688.9891) for the hearing and speech impaired. The Department’s Internet website http://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.
7 V A L L E Y H E A L T H P L A N E V I D E N C E O F C O V E R A G E A N D D I S C L O S U R E F O R M
