We’re committed to mutually respectful relationships between patients and doctors. We expect these relationships will lead to effective healthcare while recognizing people are individuals who all have different needs. We explain our expectations and set up guidelines for cooperation between patients, doctors, and clients. Patients can find this information at vsp.com.

Our patients have the right to receive services and information in their preferred language and they have the right to receive information about their rights. Our patients have the right to be treated with consideration, dignity, respect and to have VSP doctors:

• Provide complete information about their eye care and any proposed procedures and alternatives regardless of cost or benefit coverage.
• Allow patients to control decisions about their eye care treatment.
• Provide 24-hour access for ocular emergencies.
• Maintain privacy and confidentiality regarding their care.
• Make appropriate preventive health services available.
• Give prompt and reasonable responses to questions and requests.
• Provide information regarding their services and qualifications.
• Provide the VSP grievance procedures if there is dissatisfaction with services.
• Obtain input regarding services and assist them with any problems.

Our patients have the responsibility to follow preventative eye care guidelines, and:

• Check the health care benefits and exclusions of their coverage.
• Establish and maintain a relationship with their primary eye care provider.
• Give eye care providers complete and accurate information needed in order to care for them.
• Notify eyecare provider if they are going to be late or need to reschedule an appointment.
• Know the cost (co-payment, deductible, co-insurance) of their care.
• Carry out the treatment plan agreed upon with their eye care provider or primary care physician.
• Know how to access urgent, emergency and out-of-area medical eye care services.

Under the Americans with Disabilities Act of 1990, eye doctors and other health care providers are required under this federal law to provide American Sign Language (ASL) interpreter services, at no cost to the patient, to patients who need and request ASL interpreter services.

If you or a member of your staff are ASL-fluent, you may, of course, communicate with hearing-impaired patients in that manner. If neither you nor a member of your staff have fluency in ASL, make arrangements for an ASL face-to-face interpreter to assist at no cost to the patient or to you. If you need help finding an ASL interpreter, you may contact VSP Customer Care at 800.615.1883.

VSP provides Cultural Competency training on the Training & Support section of VSPOnline. Several resources addressing topics of interpretation services, better communication, health literacy and census information is available in addition to the training modules.

VSP has implemented a Language Assistance Program (LAP) to provide linguistic services to enrollees who prefer to conduct their affairs in a language other than English including the availability of free interpreter services at the time of an appointment for patients who request them.

Document Translation and Alternative Formats

Members who prefer their VSP member materials in a language other than English can receive free translation of VSP member documents, including alternative formats such as Braille, large format and audio. You may contact VSP Customer Care at 800.615.1883 for more information.

Interpretation

VSP provides telephone interpretation services to any VSP member who prefers to communicate with VSP about their benefits in a language other than English, including TTY/TDD for those who are hearing impaired.

VSP members who want to discuss their benefits in another language can call VSP at 800.877.7195 and indicate their language need. Members can also visit vsp.com to see a list of VSP practices where language(s) other than English are spoken.

You are required to keep your office(s) language capabilities current so members know where they can receive services in languages other than English. We encourage you to review practice information quarterly on VSPOnline at eyefinity.com.

Practices must keep in mind that family, friends, and minor children are considered untrained health interpreters. Using family, friends, and minor children poses a problem with patient privacy. In addition, family may impose their view of the patient and their health that can lead to less than the highest quality care desired. To request face-to-face interpretation services at no cost to you or your patient, contact VSP customer Care at 800.615.1883.

Documentation

The following items should be documented in the patient's medical record and/or patient history form:

• Patient's preferred written and spoken language
• Refusal of interpreter (if applicable)
• Use of interpreter and who (family member, minor, friend, doctor, office staff, or trained professional interpreter)
• Patient requests to have interpretation services

It is suggested to also document the patient's race and ethnicity with an option for the patient not disclose this information.

Complaints and Grievances

We make every attempt to resolve patient concerns quickly and to their satisfaction. Doctors are responsible for making sure their staff knows our complaint process and gives our complaint/grievance form to patients when they ask. You can find master copies of these forms on VSPOnline at eyefinity.com. The VSP Member Complaint/Grievance Formis available in Spanish, and Chinese.

VSP Members Privacy and Confidentiality

VSP Members have a right to request confidential communications.

VSP will provide Privacy and Confidentiality for all VSP Members including Victims of Violence and Endangered Individuals.

VSP shall permit subscribers and enrollees to request, and shall accommodate requests for, confidential communication in the form and format requested by the individual, if it is readily producible in the requested form and format, or at alternative locations. The confidential communication request shall be valid until the subscriber or enrollee submits a revocation of the request or a new confidential communication request is submitted.Confidential communication request submitted on behalf of a minor will generally expire when the minor turns 18. Confidential communication request submitted on behalf of a minor will generally expire when the minor turns 18.

The confidential communication request shall apply to all communications that disclose medical information or provider name and address related to receipt of medical services by the individual requesting the confidential communication.

Without the express consent of the requestor, VSP shall not disclose to the policyholder or another insured covered under the policy: (1) the address, phone number, or any other personally identifying information of the covered individual or any child residing with the covered individual; (2) the nature of the health care services provided to the covered individual; (3) the name, address, and phone number of the provider of the covered health care services; or (4) any other information from which there is a reasonable basis to believe the foregoing information could be obtained.

Inform the patient that they may request privacy and confidentiality by following these steps:

1. Download the Request to Restrict Use and Disclosure of Protected Health Information Form here
2. Print and complete the form
3. Mail it to:

VSP Privacy Office
3333 Quality Drive, MS 16H
Rancho Cordova, CA, 95670

1. Fax to: 916.851.4851 or
2. Email: HIPAA@vsp.com,or
3. Call VSP at 800.877.7195if you require assistance in completing the form.

VSP will implement Confidential Communication Requests within 7 days of receipt of an electronic request or within 14 calendar days of receipt by first-class mail.

For more information on domestic violence services, refer patient to the National Domestic Violence Hotline at: 800.799.7233 or TTY 800.787.3224.

Contact Information

Refer patients to VSP at 800.877.7195 or vsp.com if they ask about their Protected Health Information in regard to:

• Restrictions on the use or disclosure of Protected Health Information
• Amendments to Protected Health Information
• Revoking authorizations
• Explaining use or disclosure of Protected Health Information
• Copies of Protected Health Information