EmblemHealth Benefit Extensions Treatment Plan
EmblemHealth Extension Request for a Current Authorization
PT/OT Appeals Form
PT/OT Patient Intake Form
PT/OT Patient Outcomes Form
PT/OT Pediatric Outcomes Form
PT/OT Treatment Form
Glossary terms found on this page:
Oral or written request from a member or their designee for EmblemHealth to review or reconsider a decision made by the plan.
Services that have been approved for payment based on a review of EmblemHealth's policies.