Service Policies

Workplace Options LLC, subsidiary of TELUS Health (US) Ltd., offers an innovative employee engagement and wellness platform.  Workplace Options LLC, subsidiary of TELUS Health (US) Ltd., provides a diverse range of services to support our customers and their employees.

Workplace Options LLC, subsidiary of TELUS Health (US) Ltd. is committed to ensuring quality services and client satisfaction.  As part of our overall Quality Assurance Process, we have a formal grievance resolution process to address and resolve issues from members and customers in a timely and consistent fashion.

Guidelines

The Director of Member Experience Quality or Designee has been designated as having primary responsibility for WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. grievance and appeal system to ensure appropriate oversight and administration of all aspects, including monitoring, reviewing, and reporting to identify emerging patterns of grievances and improve plan policies and procedures.

The Director of Member Experience Quality or designee is responsible for day-to-day activities, which include the initial review, research, and logging of all standard and urgent grievances, as outlined in the Grievance and Appeal Policy.

WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. documents research, interim and final responses to the client, as well as telephonic and written responses to clients’ concerns through the grievance and appeals process. This ensures that all concerns by WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. clients are resolved in a fair and timely manner. This process has been developed to address various levels of concerns by clients including general inquiries, grievances, and appeals procedures.

Trends are analyzed and reported monthly to the Quality Assurance Committee.

Clients have the right to voice a concern about the benefits, services, access, and quality of care provided by WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. staff and providers. WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd., its providers and staff will not discriminate against members who have chosen to file a grievance. The fact that a member submits a grievance or appeal to WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. will not affect in any way the manner in which the client is treated by WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. or receives services from contracting providers. If WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. discovers that any improper action has been taken against such member, immediate steps will be taken to rectify the situation and prevent such conduct in the future.

1. WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. shall conduct a thorough investigation of the incident.
2. WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. shall determine whether adverse action was taken against such member.
3. WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. shall take disciplinary action against the offending WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. Health employee(s) who took adverse action against such member.
4. If no adverse action was taken against such member, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. shall close the investigation and save all logs, interview notes, the conclusion, and all other evidence gathered as part of the investigation in a secure electronic storage to protect private information which may have been accumulated during the investigation.

Guiding Principles

WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. is committed to the following complaint management guiding principles when handling member complaints:

1. Visibility – Information about the ‘how and where’ to file a grievance will be easily accessible to members/customers, staff and other stakeholders.
2. Accessibility – Members can easily access the grievance process and the methods of making grievances will be flexible.
3. Responsiveness – All members should receive timely acknowledgement that their grievance has been received and best efforts will be made to provide a response within the required response targets.
4. Objectivity – Each grievance will be addressed in an equitable, objective and unbiased manner.
5. Confidentiality – Personally identifiable member information should be available where needed, but only for the purposes of addressing the grievance within WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. The member’s information will be actively protected from disclosure, unless the member expressly consents to its disclosure.
6. Customer Focused Approach – A customer focused approach will be adopted and the rights of members to disagree with WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. will be respected and supported by providing and promoting as accessible a timely, fair and friendly process for the lodging and management of member/customer grievances.
7. Accountability – WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd.’s Quality Team will ensure the systematic reporting of grievances to the Quality Assurance Committee and/or the Senior Executive Group.
8. Continual Improvement – Analysis of member/customer grievances will drive improvement in customer service and the complaints handling process.

Procedure for Exempt Grievances

Grievances received over the telephone that are not coverage disputes, and that are resolved by the close of the next business day, are considered exempt grievances. A complaint case is created for each exempt grievance, and the complaint case includes the following information:

• the date of the grievance;
• the name of the client;
• complaint identification number;
• nature of the grievance;
• nature of the resolution; and
• the name of the staff member who took the call and resolved the grievance.

Exempt Grievances are included in the monthly reporting process. The quality assurance committee will meet monthly.

Examples of an exempt grievance may include a member being billed for EAP services or member not getting provider referral in correct time frames.

Procedures for Standard Grievances

Clients may register grievances with WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) by form, letter, fax, online, by calling or writing:

Workplace Options

2912 Highwood Blvd

Raleigh NC 27604

Phone:1-800-699-8011

Fax: 1-984-204-7742

qualityassurance@workplaceoptions.com

For Language Assistance services or cultural assistance, call WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) at (800) 699-801; TDD/TTY for the hearing impaired at (886) 228-2809. In addition, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) website provides an on-line form that a member may use to file a grievance online via a secure portal.  The link to this online Grievance Form is found at https://wpo.qualtrics.com/jfe/form/SV_cOzY43ZARJNpEIS. A member may initiate a grievance in any form or manner (form, letter, fax, telephone call, or online), and when WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. is unable to distinguish between a grievance and an inquiry, the communication shall be considered a grievance that initiates the Member Grievance Procedure. Members are advised, via a statement on the grievance form, that after participating in the process for at least 30 days, they may submit the grievance to the DMHC for review. Further, the member is advised via a statement on the grievance form that they do not need to complete the 30-day process if the case involves an imminent and serious threat to the health of the member.

WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. provides written acknowledgment of a member’s standard grievance and ongoing investigation within five (5) days of receipt, unless the grievance is received by telephone and can be resolved within the same day. For those grievances that can be resolved within 5 days or less of receipt, the written statement to the client of the resolution will stand as the receipt of notification and resolution. WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd.  provides for the receipt, handling and resolution of grievances, including a written response to a standard grievance, within thirty (30) days. WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. may extend the timeframe for resolution of appeals by up to 14 calendar days if the member requests the extension or if WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. shows there is need for additional information and that the delay is in the member’s best interest. If additional time (beyond the 30 days) is needed to resolve the grievance, procedures are in place to notify the member (in writing) prior to the 30th day. If, however, the case involves an imminent and serious threat to the health of the member, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd.  shall provide an expedited review. WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. shall provide a written statement on the disposition or pending status of a case requiring an expedited review no later than three days from receipt of the grievance. See expedited review section below.

Written documentation is begun the date the grievance is received by the WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. Quality Team. Assistance is provided to those clients who have limited English proficiency through a bilingual staff member or through a language assistance line. The member’s demographics are checked for accuracy in the system, the grievance is documented and if reported through a phone call, summarized and read back to the member. Grievances are appropriately categorized, and notes and comments are added to the grievance case as the investigation process is conducted by researching all issues relevant to the grievance. Upon conclusion/resolution, the grievance log is completed with all dates and actions included.

Grievances are tracked to identify any trends. Additionally, the Director of Member Experience or designee may request a review by the Chief Clinical Officer or designee for any other appropriate issue. When appropriate, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. will bring grievances to the attention of providers, request appropriate corrective actions from them, and follow-up to see that necessary changes have been implemented.

Members may file grievances for up to 6 months (180 calendar days) following any event or action that is subject to the member’s dissatisfaction.

Records of grievances are maintained by WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. for no less than five (5) years. Copies of information that WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. is required to maintain for five years shall include a copy of all case records, documents, and other relevant information upon which WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. relied to reach its decision.

Potential Quality Indicators (PQI)

All Quality of Care grievances are referred to the Quality Assurance Committee, for review, who will decide as to whether the grievance will be handled as a Potential Quality Issue (PQI).  A PQI is related to a clinical issue.

All grievances are reviewed and investigated by the Quality Assurance Committee, with oversight by the Chief Clinical Officer and/or designee. The Director of Member Experience Quality or desginee will notify the Chief Clinical Officer and/or designee of any grievance that may indicate a need for escalation. Factors that would indicate the need to classify a grievance as a PQI include the following:

• Quality of care issues: The grievance involves concerns about the standard of healthcare provided.
• Violation of professional standards: The complaint suggests care may have fallen below recognized professional standards.
• Systemic problems: The issue could indicate broader, recurring problems in healthcare delivery.
• Member safety concerns: The grievance relates to incidents that potentially endangered member safety.
• Regulatory non-compliance: The complaint suggests possible violations of federal or state healthcare regulations.

Expedited Review of Urgent Grievances

In addition to the procedures outlined in the previous section, the WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. grievance process also includes procedures for the expedited review of grievances for time sensitive situations for cases involving an imminent and serious threat to the health of a member.

WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. is notified of a case that requires urgent review, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. will advise the member of their right to notify the DMHC of the urgent grievance by email or letter sent via U.S. mail within three (3) business days. Further, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. shall, no later than three (3) days from the receipt of the urgent grievance, notify the member and the DMHC in writing of the disposition or pending status of the urgent grievance.

Policy

• TELUS Health (California) Ltd. has established a system that can receive requests from the DMHC to respond to urgent grievances.
• The system includes expediting its review when the member, an authorized representative, or provider provides notice to WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. of the grievance.
• WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. provides to members and the DMHC an available qualified representative 24 hours a day, seven (7) days a week to handle urgent grievances.
• Upon receipt of a grievance considered to be an urgent grievance by the member or the member’s representative, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. will inform the member, via email, within 72 hours of his/her right to notify the Department of Managed Health Care (DMHC).
• Before responding, Director of Member Experience Quality or designee may consult with plan personnel or others to obtain the information necessary to make an optimal decision under the particular circumstances.
• During normal work hours WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. will respond to DMHC within 30 minutes of the initial contact, and within 1 hour during non-work hours.
• WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. will provide a written response of the disposition or pending status of an urgent grievance to the member (and to the DMHC when notified of the grievance) within three (3) days of receipt.
• An extension of up to 10 additional working days beyond the three (3) days is possible if the extension of time benefits the member, such as allowing for consultations if agreed to by the member.
• An extension can also be provided if the member requests additional time in order to supply WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. with additional information for making a decision.
• WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. will notify the DMHC 30 days in advance of implementing revisions to this procedure.

Procedure for Responding to the DMHC

A call will be made to TELUS Health (California) Ltd. by the DMHC’s California HMO Help Center, the area responsible for handling urgent grievances. Below are instructions to be used by the DMHC to activate WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. process for handling urgent grievances.

DMHC Access Procedure for Regular Business Hours

• During regular business hours (Monday through Friday, from 9am to 5pm, excluding Federal holidays), the DMHC will call (888) 267-2183.
• The Call Access Center Representative will locate the person responsible for handling urgent grievances.
• The designated authorized administrative staff includes: the Senior Clinical Director of TELUS Health who will contact the Chief Clinical Officer, Sr Vice President of Global Clinical Operations and/or the Director of Member Experience Quality.
• All designated authorized staff are available via work numbers, cell phones, and email addresses.
• The designated authorized administrative staff will contact the DMHC within 30 minutes.

After-Hours DMHC Access Procedure

• After regular business hours, and on weekends and Federal holidays, the DMHC will call (888) 267-2183 and request the Manager on Call.
• The Manager on Call will contact the DMHC within one hour.

Coordination of Plan Decision-Making

• WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. will provide a written response of the disposition or pending status of an urgent grievance to the client and to the DMHC within three (3) days of receipt.
• If the grievance has been resolved in the member’s favor, the authorization shall serve as the written response.
• If the status of the grievance is pending, the Chief Clinical Officer or designee will normally prepare the required written response.
• While the DMHC is handling the review of an urgent grievance, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. is required to notify the DMHC of any impending changes in health care services that are opposed by the member or the member’s representative.

Plan Personnel Responsible for Handling Urgent Grievances

Senior Clinical Director:
Patrick Williams
During Business Hours: (763) 317-1324
E-mail: patrick.williams@telushealth.com
Office Phone: (763) 317-1324

Chief Clinical Officer:

Kennette Thigpen Harris

Mobile: 919-744-7723

Email: Kennette.thigpen@workplaceoptions.com

Sr. VP of Global Clinical Operations

Mobile: 910-262-8106

Email: crystal.fleming@workplaceoptions.com

Director Member Experience Quality

Marineuza Dias

Office phone: +35121454 2160 X74549

Email: Marineuza.Dias@workplaceoptions.com

Appeal Rights

Members are notified of their appeal rights for grievances at several times during the grievance process.

WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. provides members with written responses to grievances. Responses are to include a clear and concise explanation of the reasons for the response.

• Grievances involving the delay, denial, or modification of services based on a determination in whole or in part that the service is not EAP appropriate: for grievances involving these issues WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd will, in its written response, describe the criteria used and the clinical reasons for its decision, including all criteria and clinical reasons related to clinical appropriateness.  It also includes that the determination may be considered by the Department’s independent medical review system. An application will be provided with an envelope addressed to the DMHC in Sacramento.

The Department of Managed Health Care (DMHC) maintains a program that assists consumers with resolution of problems and complaints involving EAPs. Members are advised of the Department’s telephone number, the Department’s TDD line, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd.’s telephone number, and the Department’s Internet address in 12-point boldface type in the following regular type statement on the initial Grievance form, on the WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. five-day notification correspondence, disposition correspondence, and in notices relating to denial of services or appeals.

The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at 1-800-699-8011 and use your health plan’s grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1-888-466-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department’s Internet Web site http://www.dmhc.ca.gov has complaint forms, IMR application forms and instructions online.

Member are advised at the time of the grievance that they do not need to complete the 30 day process if the case involves an imminent and serious threat to the health of the member.

A member’s legal guardian, conservator, or relative can also submit appeals to WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. or the DMHC.

Members are expected to use WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd.’s appeal procedures first to attempt to resolve any dissatisfaction. Please see the section below on appeals for details. If the appeal has been unresolved for more than 30 days or was not satisfactorily resolved by WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd., the client may seek assistance from DMHC.

Providers, including participating and non-participating providers may assist the member in submitting a grievance to the department for resolution and may advocate the member’s cause before the department. No provider may be sanctioned by WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. for giving such assistance to a member.

The DMHC has 30 days from receipt of an IMR request to send the member and WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. a written notice of their determination (which the DMHC refers to as the notice of “final disposition of the grievance”).

There are some services that, if disputed, are not eligible for the IMR system. However, the DMHC is given the authority to require WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. to promptly offer the service or reimburse the client for it if they determine that it was a covered service and was medically necessary.

Procedures for Appeals

Appeals made to WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. for adverse decisions of grievances are handled primarily by the Quality Team. Appeals arising from adverse coverage decisions are generally handled by the Quality Assurance Committee.

Members are notified of the appeals process via their sponsoring organization/employer. This information is also located on the WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. website and includes WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd.’s toll-free number, access to telephone relay systems, notification of linguistic services and cultural assistance. Also included is the DMHC’s appeals process, the Independent Medical Review System and the DMHC’s toll-free number and website address.

A member, a member’s legal guardian, conservator, or relative can submit an appeal to WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. or to the DMHC.

WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. will retain records of appeals for a period of at least five (5) years. Information that WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. is required to maintain includes a copy of all client records, documents, evidence of coverage and other relevant information upon which WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. relied to reach its decision.

As stated in the Appeal Rights section, members are expected to use WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd.’s appeal procedures first to attempt to resolve any dissatisfaction. If the appeal has been unresolved for more than 30 days or was not satisfactorily resolved by WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd., the client may seek assistance from DMHC.

Appeals may be received by WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. in writing, by telephone, fax or online through the website.

Written documentation is begun the date the appeal is received by the Quality Team. Assistance is provided to those members who have limited English proficiency through a bilingual staff member or through a language assistance line. The member’s demographics are checked for accuracy in the system, the appeal is documented through a complaint case in the JIRA system and if reported through a phone call, summarized and read back to the member. Appeals are appropriately categorized, and notes and comments are added to the grievance document as the investigation process is conducted by researching all issues relevant to the appeal, including reviewing the original grievance and its disposition and additional information submitted and any clinical care aspects. The appeal, also called a second level review, is evaluated by the appropriate individual, usually the Chief Clinical Officer, his/her designee, or the Director of Member Experience Quality. This cannot be the same individual that made the initial determination regarding the grievance. Upon conclusion/resolution, the document log is completed with all dates and actions included.

Appeal determinations will be made within 30 days of the receipt of the appeal. The member will be notified in writing, by that time, of WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd.’s decision.

As with a grievance, an adverse decision on a first appeal/second level review can be appealed further. If the first appeal has been unresolved for more than 30 days or was not satisfactorily resolved by WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd., the client may seek assistance from DMHC, as stated in the appeal notification letter and the EOC.

For urgent appeals, the same process applies as with an expedited review. See prior section on Expedited Review.

Review by the Department of Managed Health Care (DMHC)

After participating in the grievance process for at least 30 days, or less if the member believes there is an imminent and serious threat to his or her health, and the DMHC agrees there is such a threat to his or her health, or in any other case where the DMHC determines that an earlier review is warranted, the member may register unresolved disputes for review and resolution by the DMHC. Included in member communication, as appropriate, is the required language pursuant to Knox-Keene Health Care Act section 1368.02(b) and California Health and Safety Code section 1300.68(d)(4).

Reporting

Overview

In order to evaluate opportunities for administrative practice improvements, referral process improvements, and educational opportunities for members and providers, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. collects and analyzes member satisfaction information, including, but not limited to, appeals and grievance data, summary of processes and summary of disposition and outcomes.

On a monthly bases, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. reports the results of these evaluations to the Quality Assurance Committee, which may make recommendations for change based on these results. WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. reports results and requests that the Quality Assurance Committee make recommendations for changes, if any, based on these results.

Internal Reporting

1. WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. maintains a written record (log) of all grievances received either orally or in writing from members.
2. The written record, at a minimum, includes the date, identification of the member, identification of the individual recording the grievance (if different than the member), the WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. staff who initiated the records, WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. staff who reviewed and/or resolved the issues, actions taken to resolve the issue(s), and the disposition(s) of the resolution(s), inclusive of dates, and record of 5-day notification, interim notification, and 30-day resolution response.
3. All standard and urgent grievances and appeals are initially categorized in accordance with the categories below. All grievances that involve a potential quality of care issue are routed to the Chief Clinical Officer or his/her clinical designee for resolution and follow-up.

DMHC Categories

Access to Care

Coverage Disputes

Quality of Care

Quality of Service

4. WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd.’s grievance system includes a system of aging of grievances that are pending and unresolved for 30 days or more and summary reports in various categories for tracking and trending data analysis.
5. A written record of tabulated grievances, summary of process, and summary of disposition and outcomes are reviewed by the Quality Assurance Committee quarterly.

External Reporting

1. TELUS Health (California) Ltd.’s grievance system also provides the DMHC (“Director”) with a quarterly report of grievances pending and unresolved for 30 or more days within WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd.’s grievance system.
2. The report shall not include complaints filed outside WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd.’s grievance system in other complaint resolution procedures.
3. The quarterly report shall be prepared for the quarter ending on March 31st, June 30th, September 30th, and December 31st of each calendar year.
4. The quarterly report shall not include personal or confidential information with respect to any client.
5. The TELUS Health (California) Ltd. Quality & Insights Manager is authorized to sign the report.
6. For each of the grievances identified in the quarterly report TELUS Health (California) Ltd. shall include a brief explanation of the reasons each grievance is pending and unresolved for 30 days or more.

Arbitration

Any dispute between the WORKPLACE OPTIONS LLC SUBSIDIARY OF TELUS HEALTH (US) Ltd. and the subscriber or any member arising under, out of, in connection with or in relation to the Subscriber Agreement must be submitted to binding arbitration under the authority of the Federal Arbitration Act and must be determined by arbitration administered by the American Arbitration Association pursuant to its then-current commercial arbitration rules and procedures which are available here: https://www.adr.org/Rules.  The number of arbitrators will be one (1).  The seat of the arbitration, and the place where arbitration must be conducted is Sacramento, California.  The governing law will be the substantive law of the State of California.  Any arbitration must be on an individual basis and the parties and the arbitrator will have no authority or power to proceed with any claim as a class action or otherwise to join or consolidate any claim with any other claim or any other proceeding involving third parties.

To request arbitration, a written notice (also called a demand), including a statement describing the nature of the dispute, the amount involved, the remedies sought, and a declaration that the party seeking arbitration has previously attempted to resolve the dispute, shall be sent to:

Workplace Options

2912 Highwoods Blvd

Raleigh NC 27604

1-800-699-8011

Inclusive Statement

The Plan does not discriminate against any employee, Provider, Subscriber, or applicant, because of race, religion, color, sex, age, marital status, handicap status, veteran status, sexual orientation, gender identity, gender expression, ancestry or national origin or any other characteristic protected by law. Neither the Plan nor any of its EAP Providers will discriminate against an Enrollee based on the filing of a Grievance. If you believe that you have been discriminated against due to your filing a Grievance, please notify us by calling the Contact Center at 1-800-699-8011.