EmblemHealth recently reached an agreement with the New York State Office of the Attorney General. As part of the settlement, we will reimburse current or former Medicaid managed care, Health and Recovery Plan, Child Health Plus, Essential Plan, Qualified Health Plans, and commercial members (including members in plans offered by City of New York) who may have paid out-of-network cost shares for behavioral health services, in excess of your plan’s copayment/coinsurance or deductible, received between Jan. 1, 2020, and Feb. 19, 2026.
If you believe this applies to you, use the Member Behavioral Health Restitution Form mailed to you to submit your claims for review by mail, or email the claim to claims@emblemhealthrestitution.com. You can also visit emblemhealthrestitution.com to fill out the form online. Submit one form per member for each provider seen. Provide proof of your claim (Explanations of Benefits (EOBs), receipts).