Complaints and Grievances
- VSP makes every attempt to resolve complaints and grievances expeditiously and to the member’s satisfaction. VSP network doctors are responsible for ensuring office staff is informed of the VSP Member Complaint Process and provide a copy of the VSP Member Complaint/Grievance Form to patients upon request. The VSP Member Complaint/Grievance Form is available in English, Spanish, and Chinese, and can be found in the Patient Education area Administration – Form Library section on VSPOnline at eyefinity.com.
Note:
For California residents see Complaints and Grievances under Patients’ Rights and Responsibilities.
For California Residents: If a provider or enrollee is unable to obtain a timely referral from a provider, a complaint may be filed with the DMHC at their toll-free telephone number (1-888-466-2219) and/or a TDD line (1-877-688-9891) for the hearing and speech impaired. The Department’s internet website www.dmhc.ca.gov has complaint forms, IMR application forms, and instructions online.
What are Complaints and Grievances?
- Complaint/Grievance – is a written or verbal expression of dissatisfaction regarding the plan and/or provider, including quality of care and quality of service concerns, dispute, request for reconsideration, or appeal made by a member or the member’s representative. This includes a written or verbal expression of dissatisfaction by a member or group contract holder who believes their plan contract has been or will be improperly cancelled, rescinded, or not renewed.
- When the plan is unable to distinguish between a grievance and an inquiry, it shall be considered a grievance.
- Neither VSP nor its contracted providers may retaliate against a member on the basis of filing a complaint or grievance, in accordance with State and Federal regulations.
- HIPAA privacy-related complaints may be submitted with or without other complaints related to quality and other services.
Quality of Care and Quality of Service Grievance
- Quality of Care Grievance – Complaints that allege concerns about the standards of care provided, which may include and are not limited to, misdiagnosis, negligent treatment, and/or incorrect prescription.
- Quality of Service Grievance – Complaints that allege concerns about the standards of service provided, which may include and are not limited to, unprofessional behavior, inappropriate disclosure of PHI, discrimination, appointment availability, and/or physical accessibility.
- When a quality of care and/or quality of service grievance is identified, VSP is required to gather medical records, a response from the contracted provider, and any additional information necessary to determine if there is sufficient evidence that deviation from clinical practice guidelines occurred, resulting in an adverse effect on the patient’s health, or a violation of applicable laws and regulations occurred.
- If no violation is found, or VSP finds insufficient evidence, the quality of care and/or quality of service complaint is closed.
Patient Satisfaction Surveys
- VSP regularly sends patient satisfaction surveys by random selection to VSP members who have received services with a VSP network doctor. If a complaint/grievance is identified through a satisfaction survey it will be sent to the appropriate department for review and resolution, following our policies and procedures described above.