Access To Care Receiving Self-Referral Services VHP contracts with its Plan Providers. Based on a Primary Care Physician’s Network, you may selfrefer to some specialists. Please contact your PCP’s office directly.
OB/GYN Self-Referral Services Any female Member may self-refer to a Plan OB/GYN. Call a Plan OB/GYN to make an appointment. To find a Plan OB/GYN, go to www.valleyhealthplan.org and use the Provider Search function or contact VHP Member Services at 1.888.421.8444 (toll-free) for assistance.
Lock-In Provision You should be aware that the “Lock-In” provision of your Benefit Plan requires you to obtain all Covered Services from Plan Providers in your Network. Except in the case of an Emergency Services or out-of-area urgent care, if you seek and receive services outside of your Plan Network without Authorization you may be responsible for the charges.
Timely Access to Care VHP provides and arranges for the provision of Covered Services in a timely manner appropriate for the nature of the Member’s condition and consistent with professionally recognized standards of practice. VHP has Timely Access to Care standards. These services are described in this VHP EOC and include: Appointment Scheduling Maximum Waiting Time Emergency Services Immediately Urgent Care appointments do not require prior Must offer the appointment within 48 hours of authorization (PCP) request Non-urgent appointments for Primary Care (PCP) Must offer the appointment within 10 Business Days of the request Non-urgent appointments with Specialist Must offer the appointment within 15 Business physicians (SCP) Days of the request Non-urgent appointments for ancillary services Must offer the appointment within 15 Business (for diagnosis or treatment of injury, illness, or Days of the request other health condition) Waiting time in provider office (to see provider) Maximum 30 minutes • A “24-hour Medical Advice Line” that Members can call at any time to obtain triage or screening for the purpose of determining the urgency of the Member’s need for care. • An Authorization system in place that allows for Members to self-refer to OB/GYN or through obtaining standing referrals to Plan Specialists. This Authorization system includes timely referrals for other Medically Necessary Covered Services through the Plan Provider Network. • A process to schedule or reschedule health care appointments. VHP has a website www.valleyhealthplan.org that directs Members to VHP Providers or to locations. The website directs you to Plan Providers, including emergency and urgent care. The website details provider telephone numbers and gives you the Urgent Care Clinic’s hours of operation. Many of our Urgent Care Clinics offer self-referral/walk-in same day urgent care services. Appointments are not necessary but it may save you time if you call ahead. • A Member Services Department, with English, Vietnamese, and Spanish-speaking representatives, who offer assistance in obtaining covered health care services and resolving V A L L E Y H E A LT 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 20
