心理健康預約等待時間與就醫權益投訴程序
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規範 VNS Health 富康醫療 Total (HMO D-SNP) 對心理健康門診及後續就診的預約等待時間標準，以及會員在無法取得符合等待時間的心理健康服務時，提出就醫權益投訴並取得替代提供者資訊的權利。適用於該計劃之會員與其指定代理人。
No material clinical or coverage changes in this revision.
心理健康預約與回應時限
心理健康預約等待時間與投訴回應時限：
Covered when the following appointment wait-time and grievance response standards are met:
ALL of the following
- Must be scheduled within 10 business days.
ALL of the following
- Must be scheduled within 10 business days.
ALL of the following
- Must be scheduled within 5 business days.
ALL of the following
- Must be scheduled within 5 business days.
ALL of the following
- Upon receipt of a member’s behavioral health grievance, VNS Health must provide the name and contact information of a provider who can treat the member’s behavioral health condition within 3 business days.
- If no appropriate in-network provider is available, VNS Health may refer the member to an eligible out-of-network provider.
ALL of the following
- By phone: 1-866-783-1444 (TTY: 711).
- By mail: Health Plans - Grievance & Appeals, VNS Health PO Box 445, Elmsford, NY 10523.
投訴提交流程與處理要求
投訴提交流程：電話或書面提交就醫權益投訴
若會員在規定等待時間內無法安排心理健康預約，會員或其指定人員可透過電話或書面向 VNS Health 提出就醫權益投訴。請致電 1-866-783-1444 (TTY: 711)，或將書面投訴寄至：Health Plans - Grievance & Appeals, VNS Health PO Box 445, Elmsford, NY 10523。
- 電話：1-866-783-1444 (TTY: 711)
- 郵寄地址：Health Plans - Grievance & Appeals, VNS Health PO Box 445, Elmsford, NY 10523
投訴處理與必要轉介：三個工作日回應並視需轉介網絡外提供者
收到心理健康就醫權益投訴後，VNS Health 必須在三 (3) 個工作日內提供可治療該會員之提供者姓名與聯絡資訊；若計劃網絡內無合適提供者，VNS Health 可轉介網絡外合格提供者以提供治療。
- 回應時限：收到投訴後三 (3) 個工作日內提供可治療提供者的姓名與聯絡資訊
- 若網絡內無適當提供者，可轉介網絡外合格提供者
名詞定義
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.