Member Grievances

We hope you are happy with the Vaya Tailored Plan. If you are not satisfied or have a complaint (called a grievance under Medicaid), you may talk with your primary care provider or contact Vaya. Vaya has a “no wrong door” approach to grievances, which can be submitted in any of the following ways: 

A grievance and a complaint are the same thing. Contacting us with a grievance means that you are unhappy with Vaya, your provider, or your health services. Most problems like this can be solved right away. Whether we solve your problem right away or need to do some work, we will record your call, your problem, and our solution. We will notify you in writing to confirm that we have received your grievance. We will also send you a written notice when we have finished working on your grievance.

You can ask a family member, a friend, your provider, or a legal representative to help you with your grievance. If you have questions about the grievance process or need our help because of a hearing or vision impairment, or if you need translation services or help filling out any forms, call Behavioral Health Crisis Line at 1-800-962-9003.

Resolving Your Grievance

We will let you know in writing that we got your grievance within 5 days of receiving it. 

• We will review your complaint and tell you how we resolved it in writing within 30 days of receiving your complaint.
• If your grievance is about your request for an expedited (faster) appeal, we will tell you how we resolved it in writing within 5 days of getting your complaint.

If you are not satisfied with how Vaya resolved your complaint, you may appeal our decision in writing within 7 calendar days from the date of the resolution notice. The notice will include information on how to file an appeal. You can request an appeal in several ways:

Your appeal will be reviewed within 15 calendar days from the date Vaya receives your request. Once a decision is made, Vaya will send you a written Appeal Resolution Notice, which informs you of our final decision, within the following 15 days. There is no further appeal beyond this review.