FAQ's (Frequently Asked Questions)

What are my benefits and whom do I call with questions at Valley Health Plan (VHP)?

The best way to find out about your benefits is to read your "Member Handbook" that comes in the mail with your New Member Packet. Customer Care Associates are always eager to answer your questions. They are available Monday - Friday from 8 AM - 5 PM at 715-836-1254 or toll free 800-472-5411.

How do I change my address?

You can change your address via the Internet by completing the "Contact Us" section on this Web site or by mail using a Change Form provided by your group benefits manager. VHP's address is: 2270 EastRidge Center, Eau Claire, WI 54701.

How do I get a new ID card?

You may request a new ID card by using "Contact Us" or by calling Customer Service by phone.

How do I add a new dependent to my coverage?

Children, adopted children, spouses and others depending on your coverage are eligible to be covered as dependents. Complete a Change Form available from your group benefits manager or call Customer Service to request a form. You need to be aware of your group's definition of a dependent child and the eligibility requirements. Periodically, our members receive a questionnaire in the mail checking dependent status. The questionnaire must be completed and returned to VHP in order to continue coverage for your child if he/she continues to meet the eligibility guidelines. If this questionnaire is not returned, the child's coverage will be terminated.

I just got divorced, how do I take this dependent off my coverage?

Complete a Change Form available from your group benefits manager or call Customer Service to request a form.

How can I find a participating provider:

Try our online provider directory search. Participating providers can be found for all our plans, or you can call Customer Service and request a Provider Directory.

Will I be covered if I am traveling out-of-state?

Yes. If you are traveling or are a student living outside of the VHP service area, initial services are covered for emergency and urgent care according to the benefit plan your employer has chosen. All follow-up care must be received from a Plan Provider unless you have received an approved VHP authorization prior to the care being provided.

Should I call first before going to an emergency room?

VHP does NOT require you to get authorization to go to the emergency room. Our first priority is to make certain our members get the care they need when they need it. All VHP clinics have 24-hour answering services that will put you in contact with the on-call physician. If you are experiencing symptoms which, without immediate medical attention, will result in serious jeopardy to your health, please go to the nearest emergency or urgent care center. You do not need to call VHP first. Any emergency or urgent care services will be eligible for payment subject to your contract. Co-payments, coinsurance or deductibles are your responsibility.

What Requires a Prior Written VHP Authorization?

Prior Written VHP Authorization (PWVA) is required to receive covered services from a provider other than a VHP network physician or as specified in the Benefits section of your handbook. There may be some services that require PWVA even when ordered or rendered by a VHP provider. For example, some durable medical equipment (hospital beds, wheelchairs, etc.); home care and nursing home stays; and certain tests or treatments. Please refer to your Benefit Handbook or call the Customer Relations Department for services requiring PWVA. Mayo Clinic in Rochester, Minnesota is not a Network Provider, therefore does require a PWVA. Authorization must be approved by VHP prior to services being done.

How do I get a Prior Written VHP Authorization?

You need to let your practitioner know you have VHP coverage when a PWVA is required. They will then send a request for authorization to VHP, which is reviewed by the VHP Medical Director. Generally, within two to three working days, a written response with the decision is sent to you, your VHP practitioner and the provider you are being referred to. You may contact our Customer Service Department with any questions regarding our authorization process or to check if VHP received a request for authorization.

How will I know what will be covered for those services requiring Prior Written VHP Authorization?

You will receive a written response from VHP. It will specify the duration and specifics of the approved covered service(s). You may also contact our Customer Service Department with any questions you have regarding the PWVA.