Frequently Asked Questions - English

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tio s e u Q d ske A y l t n e Frequ Can I make automatic reoccurring payments?

Yes, it’s easy to register for an automatic payment account! Visit www.valleyhealthplan.org to enroll today.

How do I pay my bill?

VHP offers three options: 1. Online: register for automatic payments or just make a one-time payment 2. In-person: visit the VHP office to make a one-time payment 3. By mail: send a check or money order to the Standard or Overnight Mail Payment Center

How do I request a refund if I overpaid?

Members can request a refund of overpaid balances by contacting Member Services. Refunds normally take 6-8 weeks to process.

How can I change my doctor?

Members, or brokers on behalf of their clients, can request to change their Primary Care Practitioner by contacting Member Services. Changes to their doctor can be requested as often as they like. The change will become effective on the first day of the following month.

What doctors and facilities are in the VHP Provider Network?

Visit www.valleyhealthplan.org to browse the VHP Network Provider Search Tool. Please note, an OBGYN cannot be assigned as a Primary Care Practitioner. Also, a pediatric doctor can see patients who are 17 years of age and younger.

When will my new Member ID Card be mailed out?

Member ID Cards are mailed out after your first premium payment is made and your Primary Care Practitioner (PCP) is assigned. If you would like to choose a specific PCP, you may contact Member Services to make the change.

1.888.421.8444 (toll-free) | www.valleyhealthplan.org | MemberServices@vhp.sccgov.org | 2480 N. 1st St., Ste.160, San Jose, CA 95131

How do I request a replacement Member ID Card?

New Member ID Cards can be requested by contacting Member Services. You will receive your new card within 2-3 weeks. During this time, you can fill out and print a Temporary ID Card found at www.valleyhealthplan.org under Member Materials > Forms and Resources or by typing “temporary ID card” in the search bar.

How do I access my member portal?

Covered California and Individual & Family Plan members can access the member portal at www.valleyhealthplan.org/memberportal. The portal provides access to eligibility and benefit plan information, claims authorization history and status, ability to change your Primary Care Practitioner, and so much more.

Does the VHP Provider Network include Stanford Hospital?

Services at Stanford Hospital and Lucile Packard Children’s Hospital require a referral and are only authorized when the services are not available at Santa Clara Valley Medical Center.

How can I apply for Continuity of Care?

New members who have a previously established service relationship with any non-contracted provider can apply for a Continuity of Care waiver to allow for continuation of that service relationship. All applications are considered on a case by case basis with the final review/decision made by VHP. NOT ALL CONTINUITY OF CARE APPLICATIONS WILL BE APPROVED. All calls for Continuity of Care are screened through Member Services. Predetermination reviews for shoppers would require the submission of medical record copies to VHP. The predetermination review usually takes 1-2 business days.

Does the VHP Provider Network include Palo Alto Medical Foundation (PAMF) doctors?

No, the VHP Provider Network for Covered California and Individual & Family Plans do not include PAMF doctors.

Do I need a prior authorization to access mental health services?

No, unless appointments are for psychiatry and intensive outpatient mental health services.

Do I need a Prior Authorization to access behavioral health services?

No, however, a Prior Authorization is required for psychiatry and intensive outpatient behavioral health services.

Which pharmacy can I use?

Members can go to any nationwide Walgreens, Safeway and Costco pharmacies, statewide Raley’s pharmacies, and countywide Valley Health Center pharmacies. Mail order prescriptions can be submitted through any nationwide Costco pharmacy. (Costco membership is not required.)

I am traveling out of the country. Are emergency and urgent care services covered?

Yes, emergency and urgent care services are covered worldwide. However, you will need to pay cost in full for these services and then seek reimbursement from VHP (Plan co-pays, deductibles, and any cost share apply).

1.888.421.8444 (toll-free) | www.valleyhealthplan.org | MemberServices@vhp.sccgov.org | 2480 N. 1st St., Ste.160, San Jose, CA 95131