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Referrals / prior authorizations

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Valley Health Plan (VHP) works with primary care physicians (PCPs) and other providers to provide and coordinate your covered services and benefits. As a VHP member, you must get all of your care from VHP plan providers. The only exceptions are emergency services, out-of- area urgently needed services, or if VHP has pre-approved services. 

If you get care outside of the VHP Network without pre-approval, you may be responsible for the costs. Your PCP provides, arranges, or coordinates all services covered by VHP. To get care that needs a referral or prior authorization:

  1. Your VHP PCP must start the referral or prior authorization process. This includes referrals to specialists. 
  2. Your PCP must complete a prior authorization request via VHP Access portal.
  3. VHP will review and make a determination on the request. 
  4. VHP will notify you and your PCP in writing if a referral or prior authorization request is approved or denied. 
    • VHP has five business days to process a routine request and 72 hours for urgent requests.

You must have approval from VHP before you can receive services. If you think your referral or prior authorization request was wrongly denied, you have a right to file a grievance. To do so, call VHP Member Services at 888.421.8444 (toll-free). It is important to file this grievance within 180 days of the initial denial. 

VHP Member Services can help with questions about utilization management, authorizations, and referrals. They are available Monday to Friday, 8 a.m. to 5 p.m. Messages after normal business hours are returned on the next business day. Messages after midnight Monday to Friday are responded to on the same business day.

If you are hearing or speech impaired, TTY/TDD services are available through the California Relay Service (CSR) by dialing 711 or the 800 CRS number of your modality.