GVHP Service Area (ZIP Codes)

The GVHP service area consists of the townships and towns located in the majority of Kent County, eastern Ottawa County, northern Allegan County, and western Ionia county

For a full zip code listing, please see the complete Service Area listing in the Provider Directory or please contact your Customer Service team at 616-949-2410.

GVHP Quality Program

GVHP believes in quality. We believe quality should be part of our health care delivery. We also believe it should be part of the service we offer our members. GVHP shows quality. Here are a few ways we do this.

GVHP goes through an accreditation process. This means we must go through a thorough review process. Some managed care organizations choose to go through this process to demonstrate quality. The National Committee on Quality Assurance (NCQA) is a nationally recognized organization. NCQA "gives a seal of approval" to managed care organizations on how well they "do quality." GVHP has gone "under the microscope," so to speak. This is one way we can demonstrate quality. We are also authorized by the Office of Financial and Insurance Services (OFIS). We report regularly to them about our quality, service and delivery measures. GVHP must meet OFIS standards on a regular basis.

GVHP also measures quality. We do this in several ways. GVHP participates in the Health Employer Data Information Set (HEDIS). On an annual basis, GVHP measures the effectiveness of its care. We measure such things as immunizations and well child visits. Prenatal and postnatal care as well as breast and cervical screenings are also reviewed. Some other things we measure include diabetic eye exams and member satisfaction. HEDIS information is reported locally and nationally. GVHP regularly measures up well on its HEDIS and quality performance.

GVHP also has a Quality Program. This program is measured and evaluated by the GVHP Performance Improvement Committee. This Committee reviews quality indicators for care and service on a regular basis. Annually, we report the results of our program to our Board of Directors. We give this information to the Office of Financial and Insurance Services. Members and practitioners may review our annual Quality Program.

For more information, please call the GVHP Customer Service Team at (616) 949-2410.

Other Sources of Information About GVHP

Where can you learn more about GVHP? GVHP believes it is important for members and customers to have information about GVHP. We give our members information on a regular basis. We also give information to our employers and providers. Here are some ways we regularly "talk to" you.

On a quarterly basis we publish our member newsletter, HealthLine. Practitioners also receive a copy. HealthLine provides current information about healthy living, upcoming GVHP events, health education classes and general plan information.

We provide health information cards about commonly asked health questions. These are free of charge. You may find them at your GVHP Family Practice Office.

We will also send letters to our customers from time to time. We do this when we want to share new or important information. For example, you receive a letter when changes are made to your Certificate of Coverage. You may also receive a letter regarding changes made to your benefits by your employer.

GVHP would like to encourage you to visit our website for informational links. The web address is: www.gvhp.com. Now available for review on-line: the GVHP Member Handbook, GVHP Notice of Privacy Practices, Member Rights and Responsibilities, Provider Directory and Provider Qualifications. Also available on-line are basics on how to access care and other unique facts about Grand Valley Health Plan. You can also find on the GVHP website pictures and maps to each of our several area GVHP Family Practice Office locations. Click on "contact us" to e-mail your comments or suggestions directly to GVHP.

For any and all questions, you can always call your GVHP Family Practice Office. Or, you may call the GVHP Customer Service Team at (616) 949-2410.

Frequently Asked Questions

How do I choose a GVHP Family Practice Office?

GVHP has seven (7) GVHP Family Practice Offices. They are conveniently located. All are within a 30-minute drive from most homes or businesses as well as acute hospitals within the GVHP service area. You may choose a GVHP Family Practice Office closest to where you live or where you work. The choice is yours. Whichever GVHP Family Practice Office you choose, you will get a complete GVHP Family Practice Office Team. (For more information, see GVHP's Team Approach to Health Care in your handbook.)

How do I use my GVHP Family Practice Office?

You can use your GVHP Family Practice Office for:

• Routine care - simply call and make an appointment
• Urgent care - even after hours, call your GVHP Family Practice Office
• Even in an emergency, if time permits, you can call your GVHP Family Practice Office
• 24 hours a day coverage, 7 days a week

For more information, see GVHP Family Practice Office Hours and After Hours Care in your handbook.

How do I change my GVHP Family Practice Office?

While most members are happy with their first choice, there may be times when you may wish to change GVHP Family Practice Offices. Simply choose from the other GVHP Family Practice Offices. You may complete a GVHP Family Practice Office Transfer Form at your current GVHP Family Practice Office. Or, you may call the GVHP Customer Service Team at 616-949-2410 to request a change form. (For more information, see Changing GVHP Family Practice Offices in your handbook.)

How do I establish a relationship with my GVHP Family Practice Office Team?

Call your GVHP Family Practice Office and arrange for a tour. This will give you the chance to see the office and meet the people who will be caring for you. At that time, we can help you arrange to transfer any records, if you are not transferring from another GVHP Family Practice Office. As you continue with your care, become an involved consumer. Ask questions. Listen carefully to the information your Health Care team shares. Keep true to your treatment plan. This is also very important. And, if you have any questions or concerns, do not hesitate to ask your team. (For more information, see Making Decisions About Your Health Care in your handbook.)

If I have lost or misplaced my membership card (or need a member handbook, provider Directory, Notice of Privacy Practices or Certificate of Coverage), how can I receive a new one?

If for any reason you need a new ID card, just ask your GVHP Family Practice Office. Or, you may call your GVHP Customer Service Team at 616-949-2410. A GVHP Family Practice Office or GVHP Customer Service Representative will be happy to help you with your request. (For more information, see Your Membership Card in your handbook.)

Should I tell GVHP if I ever have other health insurance?

Always let your GVHP Family Practice Office or GVHP know that you have other coverage. This helps us coordinate benefits with your other plan. When you come for a visit, the Patient Care Coordinator will ask you at check-in for this information. Or, you can call your GVHP Customer Service Team at 616-949-2410. (For more information see the Coordination of Benefits and Subrogation section in your handbook.)

Should I notify GVHP if I change my address?

Yes, let us know as soon as possible. We do not want you to miss important health plan or event information. Your current address helps us stay in touch with you. Just let your GVHP Family Practice Office Patient Care Coordinator know of this address change at your next appointment. Or, simply call your GVHP Customer Service Team at 616-949-2410. (For more information, see Changes to Your Membership Information in your handbook.)

How can I add newborn children to my policy?

Generally, newborns are added within 30 days of birth. Your company might have different eligibility rules. You might want to check with your employer. However, at your child's first GVHP Family Practice Office visit, we will "mini-register" him or her as a member. You still need to complete the necessary paperwork with your employer to add your child. Call your employer for assistance or the GVHP Customer Service Team at 616-949-2410. (For more information, see Changes to Your Membership Information in your handbook.)

How do I arrange a visit to a specialist?

Your GVHP Family Practice Office practitioner treats you for most of your specific needs. This ranges from common cold and allergy treatments to setting broken bones and diagnosing more complicated health care problems. However, your GVHP Family Practice Office practitioner might determine that your treatment would be more appropriately handled by another practitioner. You will then receive a referral to a specialist. A referral is usually valid for only one appointment. If more care is needed, you should contact your GVHP Family Practice Office for authorization. Be assured that your GVHP Family Practice Office will continue to monitor your care with the specialist. (For more information, see Referral Care in your handbook.)

How can I get a second opinion?

If you want a second opinion about a covered surgery or diagnostic procedure, consult with your GVHP Family Practice Office practitioner. He or she will determine whether a second opinion is appropriate. He or she will refer you if necessary. Second opinions are usually for consultation, not for treatment purposes. Your GVHP Family Practice Office practitioner will discuss the results of the second opinion. He or she will work with you to continue your treatment plan.

What do I do in case of an emergency?

If you need urgent care for a non-life threatening emergency, like a sprain, earache, or high fever, call your GVHP Family Practice Office. Your GVHP Family Practice Office is available 24 hours a day, 7 days a week to help you with your medical needs. Your GVHP Family Practice Office will arrange your "urgent care" needs.

If the emergency is life-threatening, such as a suspected heart attack, stroke or poisoning, go directly to the nearest emergency room. Do call your GVHP Family Practice Office when medically reasonable (within 48 hours is best) to let us know what has happened. Your GVHP Family Practice Office will arrange follow-up care.

For more information, see Urgent Care and Emergency Care in your handbook.

What happens if I get sick on vacation and am not near my GVHP Family Practice Office or Grand Valley Health Plan's service area?

You are always covered for emergency or urgent care no matter where you are. If your condition is urgent (not life-threatening), you must still call your GVHP Family Practice Office to get approval for an urgent care visit. If you are out-of-area, you may always call collect. However, if your condition is an emergency (life-threatening) and you are out-of-area, go to the nearest hospital. Call your GVHP Family Practice Office when medically possible to let them know what happened. (See your Certificate of Coverage, ARTICLE II: Benefits Schedule: Urgent Care Emergency Care and see Urgent Care and Emergency Care in your handbook.)

Are there any restrictions on benefits if I get services outside Grand Valley Health Plan's service area or health care delivery system?

GVHP is not an insurance company but a health care delivery system, which operates on a direct service basis. If you obtain health, medical, behavioral health or hospital services outside of the GVHP service area and these services are not authorized by your GVHP Family Practice Office these services are not a covered benefit. You cannot be reimbursed for these services. This restriction does not apply to emergency care.

What happens if I need to be hospitalized?

Your GVHP Family Practice Office is always the first point of contact for you and your familyÕs health care needs. Your GVHP Family Practice Office can help you with what you need to get into the hospital. Your GVHP Family Practice Office will also arrange or help with any tests or special treatment you may need. (For more information, see Hospital Care in your handbook.)

How do I get mental health services?

Just call your GVHP Family Practice Office. Ask for an appointment with one of our wellness counselors. ItÕs that simple. You will be given an appointment. At this appointment, you will be evaluated about your needs. If care is needed, you and your counselor will develop a treatment plan. (For more information, see Behavioral Health Care in your handbook.)

How do I file a complaint?

Give your GVHP Family Practice Office a call. Discuss your concerns. If you are not satisfied with the information or answers you get, then call the GVHP Customer Service Team at 616-949-2410. (For more information, see Member Complaints in your handbook.)

What if I am dissatisfied with the decision made about my complaint (or claim that has been denied)?

You have the right to file a grievance if you are dissatisfied with a decision made about a complaint. This is also your right for denied claims. Call the GVHP Customer Service Team at 616-949-2410 to request grievance information. (For more information, see Member Grievances in your handbook.)

Don't see the question you're asking? You can also check out the Questions and Answers in the Provider Directory.

Closing Thoughts

We would like to close this handbook with some thoughts about "managed care."

"Managed care" is a term that means different things to different people. We want to tell you what "managed care" means to us. We know that while "managed care" sets out to lower health care costs, it does this by keeping you healthy and out of the hospital. That's good! The quality of your life - good physical and mental health - is important! So, we know that managed care also assures that "quality" stays in the "care" you are given. That's good too! Balancing cost and quality while "delivering" care is the aim of a managed care organization. We at GVHP make these our goals.

GVHP is a health plan - not just an insurance program. We deliver care through an integrated delivery system. This system provides you with almost every aspect of health care you may need. By staying within this "delivery" system, you can get the maximum benefit allowed under your Certificate of Coverage. This means you need to work closely with your GVHP Family Practice Office team as it manages, coordinates and provides your health care.

Thank you for choosing GVHP as your healthcare partner! We look forward to "managing" your medical care. And, we look forward to "partnering" with you in achieving the best quality of health and lifestyle. Choose well!