CHECKING-IN FOR YOUR APPOINTMENT

Always check-in when you visit your GVHP Family Health Center. The Patient Care Coordinator at your GVHP Family Health Center will help you check in. Show your GVHP ID card. You will be asked to confirm information at check in. This includes your address and telephone number. We will ask if you have other insurance. Please be patient when we ask. We need to have the most up-to-date information about you. We need this information so we can stay in touch with you and to process your claims accurately and in a timely manner.

If you are a new member, you will also be given information to complete at the time of your first visit. This information is needed to set up your medical records. We want to know all about you.

PHYSICAL EXAMS AND IMMUNIZATIONS

Your GVHP Family Health Center works with you on your health care needs. There are several ways we do this. Your GVHP Family Health Center helps you know how often you need a physical exam. We tell you about preventive screening services. Immunizations are also important in keeping you healthy. Your GVHP Family Health Center helps here too.

Referral Care

You may need the services of a specialist. Your GVHP Family Health Center Practitioner will refer you.

You will go to a specialist who participates with GVHP. This means the specialist is a member of the GVHP panel. Your condition might need the services of a specialty not available through our panel. In that case, you might be referred to a non-participating practitioner. Most importantly, you will be going to a specialist we know can be trusted to give you the best care.

Your GVHP Family Health Center helps you with your referral. The Specialty Care Coordinator will make your appointment. She or he will tell the referral physician’s office where to call for authorization of further services. The Specialty Care Coordinator will tell the specialist’s office where to send the bills.

It is possible that the specialist might ask you to come back. Your GVHP Family Health Center can only authorize services it has arranged. Do not schedule another appointment without first calling your GVHP Family Health Center. Your GVHP Family Health Center will tell you if the next visit is authorized. If you go back without an authorization, you will be responsible for unauthorized visits or services.

Special Note: It is possible that your specialist may advise a service that is not a covered benefit. Your GVHP Family Health Center Practitioner might also do this. The service or product might be medically necessary. However, if it is not a covered benefit, GVHP will not pay for it. You will be responsible for paying for it.

Hospital Care

If you need inpatient or out patient hospital care, your GVHP Family Health Center team will make the arrangements. You will go to the hospital that best fits your needs. GVHP participates with the following hospitals:

• Spectrum Health Hospital Blodgett
• Spectrum Health Hospital Butterworth
• Spectrum Health Kelsy Hospital
• Spectrum Health Reed City Campus Hospital
• Spectrum Health United Memorial Hospital

Your GVHP Family Health Center physician is involved in your hospital care. He or she will work with the hospital staff to be sure you get the care that you need. A GVHP Specialty Care Nurse may also visit you in the hospital. She or he monitors your nursing care. She or he will set up any special needs you might have at home.

You will be asked to show your ID card when you go to the hospital. You should always carry your card with you. The hospital needs this information in order for you to be admitted. Bills for hospital care will go to GVHP. GVHP will pay benefits directly to the hospital.

Case Management

What is case management? Case management is focused on you. It is about quality. It is concerned about the right care. It is about your individual needs. It is not just for a single issue. It is much more than discharge planning.

This is a free service to members. It is for members with serious medical problems. These include cancer and diseases requiring transplants. Other complicated medical conditions receive case management services. These members usually have many problems and concerns that can “fall through the cracks.” We do not want this to happen. That’s why GVHP is committed to this important service.

Case management is a process. It includes finding out where you are now. It is also about planning for the future. A case manager works with you and your GVHP Family Health Center team. She or he also involves referral physicians and providers. They are all part of your case management team. The case manager helps your team develop an individual treatment plan. This might include some of the following:

• Arranging and coordinating physician-directed treatment
• Assuring communication among all parties
• Finding and obtaining community-based resources that meet the member's medical, psychological and social needs
• Keeping everyone on the team updated

Urgent Care

Urgent care involves medical care for conditions that are not life-threatening. This means your condition can wait for the time it would take to call your GVHP Family Health Center for direction. An example of an urgent condition would be a sprained ankle. You may need to seek Urgent Care when you are in the service area. For example, if your GVHP Family Health Center is closed, you may also seek Urgent Care services when you are out-of-area due to travel. Remember, urgent conditions always require a call to your GVHP Family Health Center for authorization.

If you need urgent care services, call your GVHP Family Health Center. The telephone number is on the front of your ID card.

Most likely you will go to our Urgent Care Center (UCC). Our UCC offers convenient and immediate care.

Our Urgent Care Center is located at 2680 Leonard NW. It is open everyday. Including weekends and Holidays.

Emergency Care

A medical emergency means you need attention right now! GVHP defines medical emergencies as:

• An unexpected or unforeseen onset of a traumatic bodily injury
• Life-threatening or disabling condition which;
• If not treated immediately, may result in serious physical impairment or loss of life.

Some examples of medical emergency include but are not limited to:

• Possible heart attack. You are having severe chest pain including sweating and/or nausea.
• Poisoning
• Convulsions
• Loss of consciousness
• Other acute medical conditions

If your condition is an emergency, go to the nearest hospital right away. Or, if you can, call your GVHP Family Health Center for help. If you are unable to call before going, then call when medically possible or within 48 hours.

In case of an emergency, follow these steps:

• If you believe any delay in care will result in loss of life or permanent disablement, go to the nearest hospital emergency room or call 911.
• For ambulance emergency services call 911.
• If you are not admitted, call your GVHP Family Health Center when medically possible or within 48 hours.
• Do not go to the emergency room for follow-up care. Your GVHP Family Health Center can provide this care. Or we will arrange for follow-up care. This includes on-going care. It does not matter what type of emergency it is.
• Present your GVHP ID card. Instructions about emergencies can be found on the back.

GVHP follows the reasonable prudent layperson standard for emergency care. A reasonable prudent layperson is a non-medical person. We ask the question: What would a reasonable prudent layperson do in a similar situation? GVHP pays for visits that meet the reasonable prudent layperson standard.

Pharmacy Services

Grand Valley Health Plan offers pharmacy services at all of our GVHP Family Health Center locations. In addition, Grand Valley Health Plan offers two full-service pharmacies.

GVHP pharmacies offer you the following services:

• The GVHP pharmacist will answer any questions or concerns. This will be done at the time your prescription is filled.
• The GVHP pharmacist will explain how to take your medication. He or she can give you information about precautions or side effects.
• Prescriptions can be mailed directly to your home. This is at no extra charge.
• Used all your refills? Please call the GVHP pharmacy. The pharmacy staff will call your GVHP Family Health Center Practitioner. They will arrange additional refills.
• There are certain medications that can only be filled by a GVHP Pharmacy. Check with your Practitioner for these special drugs.
• Our pharmacies and GVHP Family Health Centers also offer many over-the-counter products. These are offered for your convenience. They are at much discounted prices. Simply, ask your GVHP Family Health Center. Or ask the GVHP Pharmacy for more information.
• You may also arrange to pick up your filled prescription at your GVHP Family Health Center.

You may use the services of community pharmacies that participate with our managed care pharmacy network. This network is called MedImpact. To find out if your pharmacy is part of this network, simply ask your pharmacist.

Your prescription will most likely be filled with a "generic" drug. A “generic” drug has the same ingredients at the same dose as the brand name drug. If you want a brand name drug when a generic is available, you may request this. However, you will owe the difference between the cost of the generic drug and the brand name drug.

Radiology and Laboratory Services

GVHP offers X-ray services. These services are available at GVHP Wyoming and Beckwith Family Health Centers.

GVHP also offers a full range of X-ray services at our Diagnostic Radiology Center (DRC). DRC is located in the same building as the Beckwith GVHP Family Health Center. The services provided by the DRC include mammography, ultrasound, and x-ray services. You will find the GVHP Family Health Center and the GVHP Diagnostic Radiology Center at 2680 Leonard NE, Grand Rapids, MI. This is right off the I-96 exit. Limited X-ray services are also available at our Wyoming Family Health Center.

Your GVHP Family Health Center has laboratory services available. The GVHP Family Health Center can perform basic lab tests. Examples are strep throat, pregnancy and basic urinalysis tests. Staff at your GVHP Family Health Center can collect samples to send out for analysis. We also draw blood.

Call your GVHP Family Health Center to arrange X-ray or laboratory services. Your Patient Care or Specialty Care Coordinator will help you. She or he will schedule or arrange all your radiology and laboratory service needs. If you need additional services not offered at our location you will be referred.

Ambulance Services

As a member of GVHP, you are covered for ambulance services. If you are not sure whether you need ambulance services, you may always call your GVHP Family Health Center for help. GVHP Family Health Center staff can be reached 24 hours a day, 7 days a week.

When you need an ambulance:

• Call an ambulance if the situation is life-threatening. You may also call 911.
• Call an ambulance if you are not physically able to go directly to the nearest hospital.
• Call an ambulance if you cannot take your family member safely to the nearest hospital.