Grievance and Appeal Information

Grievance and AppealsYou have the right to file a grievance (complaint) or an appeal (ask us to review a request again). You can do this yourself or you can ask someone to act on your behalf.

The information provided below explains how to file grievances and appeals and how to request coverage decisions and coverage determinations in writing, in person and by phone. It also includes the time frames and requirements when processing these requests and the forms you may use to make your request.

Coverage Decisions and Part D Coverage Determinations Grievances Appeals Urgent-Expedited Appeals How to Appoint a Representative

If you have any questions or to request the total exceptions, grievances and appeals received by EmblemHealth, please call:

  • EmblemHealth Medicare HMO Customer Service at 1-877-344-7364 (TTY: 711), 8 am to 8 pm, seven days a week
  • EmblemHealth Medicare PDP (City of New York retirees only) call Customer Service at Express Scripts at 1-800-585-5786 (TTY: 1-800-899-2114), 24 hours a day, seven days a week.

To view Portable Document Format (PDF) files, you need Adobe Acrobat Reader. If you do not already have this software, you can download a free copy from Adobe®. Download the Adobe Reader® now. Follow Adobe's instructions for download and installation.