Grievances and Complaints
We hope Vaya Health serves you well. If you are unhappy or have a complaint, you may talk with your primary care provider or contact us.
Under Medicaid, a complaint is called a grievance. 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 inform you that we have received your grievance in writing. 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 or the grievance process. They must have your written consent to file a grievance for you. If you need our help because of a hearing or vision impairment, or if you need translation services or help filling out any forms, we can help you.
What are examples of grievances and complaints?
Grievances could involve matters such as:
- 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 your benefit plan
- Attitude of Vaya staff and providers
- Billing and financial issues
- Quality of your practitioner’s office or facility
- Healthy Opportunities Pilot (HOP) program
- Dissatisfaction with your care manager
Vaya follows a “no wrong door” approach for submitting grievances. You can file a grievance in any of the following ways:
- BY PHONE: Call Vaya’s Member and Recipient Service Line at 1-800-962-9003 or our Grievance Resolution and Incident Team at 1-800-893-6246, ext. 1600. You can also report concerns anonymously through Vaya’s toll-free, 24/7 Compliance Hotline at 1-866-916-4255.
- ONLINE: Visit the Vaya EthicsPoint compliance portal at ethicspoint.com (also allows you to report anonymously) or submit a grievance through our online Member and Recipient Portal at vayahealth.com/member-recipient-portal/
- BY EMAIL: ResolutionTeam@vayahealth.com
- BY MAIL: Write to us at Vaya Health, Grievance Resolution and Incident Team, 200 Ridgefield Court, Suite 218, Asheville, NC 28806
Vaya will let you know in writing that we got your grievance within five days of receiving it. We will review your grievance and tell you how we resolved it in writing within 30 days. This is called a resolution letter.
This timeframe can be extended by 14 calendar days if you request the extension or there is a need for additional information and the delay or extension is in your best interest.
If your grievance is about your request for an expedited (faster) appeal, we will tell you how we resolved it in writing within five days of receiving it.
If you are not satisfied with how Vaya resolved your grievance, you may appeal our decision in writing within seven calendar days from the date of the resolution notice or escalate your grievance to the North Carolina Department of Health and Human Services, NC Medicaid (Division of Health Benefits).
The resolution letter will include information on how to file an appeal with Vaya. You can request an appeal in several ways:
- BY PHONE: Call Vaya’s Member and Recipient Service Line at 1-800-962-9003 or Vaya’s Grievance Resolution and Incident Team at 1-800-893-6246, ext. 1600
- BY EMAIL: ResolutionTeam@vayahealth.com
- BY FAX: 828-398-4226
- BY MAIL: Write to Vaya Health, Attn: Grievance Resolution and Incident Team, 200 Ridgefield Court, Suite 218, Asheville, NC 28806
- IN PERSON: You may hand-deliver an appeal to Vaya’s administrative office at 200 Ridgefield Court, Suite 218, Asheville, NC 28806
Your appeal will be reviewed within 21 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. There is no further appeal at Vaya beyond this review.
For more information about escalating your appeal to NC Medicaid, you can contact the NC Medicaid Ombudsman at us at 877-201-3750 from 8 a.m. to 5 p.m., every Monday through Friday except for State holidays.