What is a grievance or complaint?
A grievance is a complaint or concern about any matter other than a decision to deny, reduce, terminate or suspend your services (which are called “adverse benefit determinations”). Examples of grievances and complaints include concerns about:
- Staff not keeping an appointment or being late to an appointment
- Staff not being respectful to you
- Concerns about provider quality of care
- Lack of access to services where you live or services that are not allowed on the benefit plan
- Attitude of Vaya staff and providers
- Billing and financial issues
- Quality of your practitioner’s office or facility
You have the right to file a grievance or complaint with Vaya either verbally or in writing. To file a grievance, call Vaya Member Services at 1-800-849-6127. You can also send an email to email@example.com or mail your grievance to: Vaya Health, Attention:
Attn: Resolution Team
200 Ridgefield Court, Suite 206
Asheville, NC 28806
You can also file a grievance in our EthicsPoint compliance portal. This website allows you to file a grievance or complaint anonymously, if you wish.
If you want to discuss your concern informally before filing a grievance, you can contact our Resolution Team at 828-225-2785, ext. 1600. You may also share your concerns with your Vaya care manager or another person working with you (if you are comfortable discussing your concerns with that person).
When you call to report a complaint or grievance, Vaya staff will make a written record of your concern. We will send you a written notice acknowledging receipt of your grievance within five calendar days from the date your grievance is logged. When Vaya receives your grievance, it is assigned to the department that can best respond to your concerns. If your grievance involves serious health and safety issues, we will notify our Chief Medical Officer and take immediate action, if needed.
If a Vaya network provider is involved with your grievance, we will try to resolve your grievance directly with the provider. However, you are not required to use your service provider’s grievance process first before contacting Vaya.
To resolve your concerns, a Vaya staff person may contact you and others involved with the grievance to help resolve your concerns. This may include:
- Talking with you or your legally responsible person (LRP), if applicable
- Talking to your provider or others involved in the situation
- Consulting with experts at Vaya, such as our Chief Medical Officer or legal counsel
- Reviewing your medical record to obtain information related to your grievance
We will make every effort to resolve your grievance within 30 days from the date of receipt. Under federal law, we have up to 90 days for resolution, and that timeframe can be extended by another 14 days if you request an extension or we believe an extension is justified.
We will mail you a written notification explaining the resolution of your grievance. The notification will specify if your grievance is referred to another agency, such as the state Division of Health Service Regulation (if a licensed facility is involved).
What if I’m not satisfied with the response to my grievance or complaint?
Vaya’s policy is to offer you the right to appeal the resolution of a grievance or complaint if:
- You are not satisfied with the decision;
- Vaya is unable to resolve the grievance or complaint within the specified timeframe; and/or
- Vaya is unable to notify you of the final decision.
How do I appeal a grievance or complaint resolution?
You will receive a resolution notice with information on how to file an appeal. You have seven calendar days from the date of the notice to request an appeal in writing, either by email, fax or regular mail:
- By email: firstname.lastname@example.org
- By fax: 828-398-4226
- By mail: Vaya Health, Attn: Resolution Team, 200 Ridgefield Court, Suite 206, Asheville, NC 28806
You may also hand-deliver an appeal to a Vaya office listed on our Contact Us page.