Customer Service

We're committed to taking care of our members.
And your health is only part of it.

Customer ServiceAlong with providing you with the health care coverage you need, we take pride in making sure you have a good experience when you are using your benefits. Our goal is to provide you with excellent customer service, answer your questions, and always treat you with respect. That's the EmblemHealth difference. The following questions and answers provide excellent information about our commitment to customer service. If you have questions that aren't addressed here, we encourage you to call Customer Service at 1-855-283-2146.

What if I have questions about my plan?

If you have Medicaid Managed Care or Child Health Plus with EmblemHealth, please call our Customer Service department at 1-855-283-2146. Our staff is available Monday through Friday (excluding major holidays), 8 am to 6 pm, and our automated service is available 24 hours a day, seven days a week. You may also log in to myEmblemHealth, 24 hours a day, 7 days a week to:

  • Review the most up-to-date listing of network doctors and other providers
  • Select or change your PCP
  • Request a replacement ID card
  • View your benefits
  • Change your PIN
  • Read member newsletters
  • View frequently asked questions
  • Get preventive health information
If your child is already a Child Health Plus member, please have his or her ID available. If your child is not yet a member, please be ready to provide your or his or her Social Security number.

How can I find out who my dentist is?

Healthplex is the company we contract with to provide dental services to our members in EmblemHealth’s Medicaid and Child Health Plus programs. You and other enrolled family members are assigned to one of our network primary care dentists as of your effective date of enrollment. The name, address and telephone number of your dentist is included in your New Member Welcome Kit. If you do not know who your dentist is, or you want to change your dentist, please call Healthplex at 1-800-468-9868 between 8 am and 6 pm, Monday through Friday.

I just received a bill from a doctor. It says that EmblemHealth did not pay the full amount of the bill and that I must pay the balance. What should I do?

If you get a bill for a treatment or service you do not think you should pay for, do not ignore it. Call Customer Service at 1-855-283-2146 right away. EmblemHealth can help you understand why you may have gotten a bill. If you are not responsible for payment, EmblemHealth will contact the provider and help fix the problem for you.

You have the right to ask for fair hearing if you think you are being asked to pay for something Medicaid or EmblemHealth should cover. You can view your fair hearing rights here. If you have any questions, call Customer Service at 1-855-283-2146.

How can I make a complaint about a hospital, doctor or dentist?

You may contact EmblemHealth about a complaint in one of three ways: by phone, in writing or in person.

By phone:

  • 1-855-283-2146, TTY for hearing impaired and deaf members/applicants: 711
  • Customer Service staff are available to help you Monday through Friday (excluding major holidays), 8 am to 6 pm. At other times, leave information on the answering machine. Make sure to give enough detail for us to understand your problem. We will return your call the next working day.

In writing:

  • You can write us a letter and mail it to:
    Grievance and Appeals Department
    P.O. Box 2844
    New York, NY 10016-2844

In person:

  • EmblemHealth
    Customer Service Member Access Unit
    55 Water Street (Entrance on Old Slip)
    New York, NY 10041-8190

The Member Access Unit is wheelchair-accessible and open Monday through Friday, 8:30 am to 5 pm. No appointment is necessary.

How can I report a fraud?

Call the Fraud Abuse Hotline at 1-888-4-KO-FRAUD to report any suspected fraud or abuse. All calls are kept private. A representative will look into the reason for your call.