Making the choice of health care coverage for you and your family is one of the most important decisions you face. At GVHP, we want you to have as much information as possible to make the best choice for your needs. Below are some answers to commonly asked questions, and information that should help you CHOOSE WELL.
How do I use GVHP?
You simply select the GVHP Practitioner or Family Health Center that is most convenient for you. Always call your Family Health Center for all of your health care needs. Your health care team will direct you on what to do next. Most of your health care needs will be met at your Family Health Center. If your Family Health Center is unable to provide a service they will direct you to the right place for the care you need.
Are Grand Valley Health Centers Accepting New Patients?
Yes. Unlike independent doctors who set limits on the number of HMO patients they’ll see or how often they’ll see them, our Family Health Centers are always dedicated and open to new members.
Can I Choose my Own Doctor?
As a Grand Valley Health Plan member, you can choose a GVHP Practitioner of your choice, or you can choose a Family Health Center closest to where you live. Whichever GVHP location you decide on, you will have an entire team dedicated to providing your care. Each Family Health Center is staffed with a team of professionals, including Family Physicians, Physician Assistants (PA’s), Nurse Practitioners (NP’s), Nurses, and Health Coaches (Behavioral Health Counselors and Nutritionists). Your patient care coordinator is there to help you in scheduling visits with the right team member, at the right time. Even though you may see other practitioners, your Primary Care Practitioner has access to the medical records for all
of the medical care you and your family receive within our health care delivery system.
What if I am Currently Getting Care from Another Physician?
When you choose Grand Valley Health Plan, you choose one of our Primary Care Practitioners as your new doctor. If you are currently getting treatment from another doctor, we will work with you to make sure your care is transitioned without problem. Your health care team will help you decide which practitioner best suits your needs. Where you go for care and who provides the care is based on two things: your medical needs and our experience of where you will receive the best care.
Can I see a Specialist?
At Grand Valley Health Plan, there are no insurance company limits placed on specialists’ care. Your Family Health Center Practitioner, not The Health Plan, decides when visits to specialists are necessary. All referrals and visits to medical specialists must be pre-approved and set up by your Family Health Center team to ensure integration and coordination of care. GVHP credentials and contracts with specialists to ensure quality care. For your convenience, GVHP offers an on-line, searchable provider and hospital directory at www.gvhp.com. This directory contains information on family medicine providers, specialists, and hospitals. The information found in this on-line tool is also available over the telephone or in a print copy. Simply call Customer Service at (616) 949-2410.
How are Decisions about my Health Care Made?
At Grand Valley Health Plan, we understand that each patient is special and has individual needs. That’s why we stress the importance of you and your providers working together to manage your health and make the decisions that affect you. We believe that health care decisions are the shared responsibility of patients, their families and health care professionals. Grand Valley Health Plan Practitioners share information with patients about their health status, medical conditions and treatment options. For very serious or complex medical cases, all of our internal resources, as well as outside specialists, work together to come up with the most complete plan.
How Do I Access Care?
Simply call your GVHP Family Health Center phone number, 24 hours a day, seven days a week (including holidays). If you are calling after regular office hours, a GVHP Nurse, Behavioral Health Counselor or Physician will return your call within 15 minutes. They will tell you what to do next. Regular office hours at your Family Health Center are 8:30 a.m. until 5 p.m. Monday through Friday. Each family practice health center also has extended hours which vary by location. For emergencies or urgent problems that cannot wait until your Family Health Center is open, Grand Valley Health Plan offers after-hours service. Depending on your condition, you could be sent to the GVHP Urgent Care Center. For life threatening
situations, you should go to the nearest emergency room. If you go to the nearest emergency room, call your Family Health Center within 48 hours or as soon as medically reasonable.
Are there any Special Circumstances where Decisions Need to be reviewed by My Health Plan?
There are “special services” that need to be reviewed and prior authorization from GVHP insurance company staff. This review is done by the Vice President of Medical Affairs (VPMA). The VPMA is also known as the medical director. These “special services” are:
- Out-of-Area Care
- Cosmetic procedures
- Investigational or Experimental Procedures
- Requests for New Technology
- Bariatric Surgery
There is a process for looking at these requests. It is called the GVHP Medical Opinion Process. Your Family Health Center Practitioners help in this process. You only need to speak with him or her about treatment options. The Family Health Center Practitioner makes the request and completes the necessary paperwork. The Family Health Center then gives medical information to the Medical Director. The Medical Director will work with your Family Health Center team in getting you an answer about coverage. If you have questions about these types of utilization decisions, GVHP staff is available to answer your questions between 8 to 5 pm by calling (616) 949-2410 or (877) 999-6442.
Am I Covered in Case of an Emergency Anywhere in the World?
Grand Valley Health Plan provides emergency coverage anywhere in the world for life-threatening situations. If you are not sure if your problem is an emergency, call your Family Health Center immediately for what to do next. If you are not able to call before going to the emergency room, please contact your Family Health Center, within 48 hours or as soon as medically reasonable. A co-payment will apply for all emergency care.
Questions about Deductibles and Deductible Plans
Questions often come up about deductible plans. Please feel free to read through this list of answers to the most common questions about deductibles. If you have additional questions about deductibles, or other Grand Valley Health Plan healthcare plan questions, please contact Customer Service at 616-949-2410.