EmblemHealth: Diversity Survey

Thank you for taking the time to fill out this survey. EmblemHealth is interested in finding out about your experience with us, your health plan, and your doctors. Your feedback will help us improve the quality and types of services you receive. Let's begin.

Required Fields are indicated with an asterisk (*).

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1. When talking with your doctor, do you prefer to use a language other than English?
2. Thinking about your most recent office visit, did your doctor speak to you in the language you prefer?
3. The following are questions about your race and ethnicity. This information helps us to better meet your needs and the needs of the communities we serve. Your answers will be kept private and will not affect your health care coverage.
Please tell us your ethnicity (select one):







4. On a scale of 1 to 5, where 1 is not well at all and 5 is very well, how well do you understand English? (choose one)
5. On a scale of 1 to 5, where 1 is not at all satisfied and 5 is very satisfied, how satisfied are you with the way you and your doctor communicate (in other words, are you comfortable speaking with your doctor about your concerns and/or do you feel your doctor explains things to you clearly regarding your health, a diagnosis, treatment, medications, etc.)?
6. On that same 1 to 5 scale, where 1 is not at all satisfied and 5 is very satisfied, how satisfied are you that your primary care doctor understands your cultural, gender, racial, ethnic, and language needs?
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7. On that same 1 to 5 scale, where 1 is not at all satisfied and 5 is very satisfied, how satisfied are you that any specialists you see understand your cultural, gender, racial, ethnic, and language needs?
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8. Do you prefer to see only doctors from your culture and/or ethnicity?
9. On that same 1 to 5 scale, where 1 is not at all satisfied and 5 is very satisfied, how satisfied are you that your behavioral health professional understands your cultural, gender, racial, ethnic, and language needs?
10. Do you prefer to see only behavioral health professionals from your culture and/or ethnicity?
11. Do you feel your doctors, specialists, and behavioral health professionals meet your health care needs?
12. On a scale of 1 to 5 where 1 is not well at all and 5 is very well, how well do you understand the information you received from EmblemHealth regarding:
12a. Privacy?
12b. Benefits (products or services that your health plan covers)?
12c. Doctor/health care professional availability?
12d. Access to services and medications?
13. Do you know where to find this information in EmblemHealth’s policies and procedures?
14. Do you know how to use your pharmacy benefits, including getting your prescriptions by mail?
15. Are you aware of the cost difference between using a doctor who is in your plan’s network compared to a doctor who is not in the network?
NOTE: There is a cost difference and you may save money by using an in-network doctor. You can find a doctor in your health plan’s network by visiting our website, emblemhealth.com, or calling Customer Service.
16. Do you feel your health plan offers enough primary care doctors, specialists, and behavioral health professionals to choose from that meet your cultural, gender, racial, ethnic, and language needs?
17. On a scale of 1 to 5 where 1 is very dissatisfied and 5 is very satisfied, how satisfied are you with the overall number of primary care doctors, specialists, and behavioral health professionals in your plan who speak your language and meet your cultural, gender, racial, and ethnic needs?
18. Have you called Customer Service or used EmblemHealth’s website to review your benefits, claims, or medications; request ID cards; change your primary doctor; learn how and when to obtain a referral (permission from your primary doctor to see a specialist) or authorization (approval); or find out your cost for a service or treatment from a health care professional or facility?
19a. Has your doctor asked for an authorization (known as an approval) or referral (permission from your primary doctor to see a specialist) for services during the last year?
19b. If a request is denied, did you know that you or your doctor can file an appeal? This means you or your doctor can ask us to review your request again.
20. Thinking about the last visit with your primary care doctor, how satisfied were you with the services you received? Use the same 1 to 5 scale where 1 is very dissatisfied and 5 is very satisfied.
21. If you saw a specialist, how satisfied were you with the services you received during your last visit? Use the same 1 to 5 scale where 1 is very dissatisfied and 5 is very satisfied.
22. If you saw a behavioral health professional, how satisfied were you with the services you received? Use the same 1 to 5 scale where 1 is very dissatisfied and 5 is very satisfied.
23. Please tell us what kind of doctors, specialists, or behavioral health professionals you’d like to see EmblemHealth offer. Please include information regarding their language, race, culture, ethnicity, and location.

HIP Health Plan of New York (HIP) is a HMO plan with a Medicare contract. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company.