TABLE 21-2, FIRST MEMBER LEVEL COMPLAINT - EXPEDITED | |||||
COMMERCIAL AND CHILD HEALTH PLUS PLANS | |||||
BENEFIT PLAN(S) |
WHAT/HOW/WHERE TO FILE |
TIME FRAMES |
ADDITIONAL RIGHTS |
||
Initial |
EmblemHealth Acknowledges Receipt |
EmblemHealth Determination Notification |
|||
HIP Commercial, |
Write to: EmblemHealth Telephone: |
60 business days from event. |
N/A |
Verbal response within 48 hours of receipt of necessary Written notice sent within 3 business days of determination |
May file a second level complaint, Additional complaint may be filed with the NYS DOH at any time by calling 1-800-206-8125. |
GHI HMO |
Write to: GHI HMO Telephone: TTY/TDD: 711 Fax to: |
90 calendar days from event. |
N/A |
Verbal response within 48 hours of receipt of necessary Written notice sent within 3 business days of determination. |
May file a Additional complaint may be filed with the NYS DOH at any time by calling |
GHI and |
Write to: EmblemHealth/GHI Telephone: |
90 calendar days from event. |
N/A |
Verbal response within 48 hours of receipt of necessary Written notice sent within 3 business days of determination. |
May file a |
TABLE 21-3, FIRST LEVEL MEMBER COMPLAINT - STANDARD |
|||||
COMMERCIAL AND CHILD HEALTH PLUS PLANS |
|||||
BENEFIT PLAN(S) |
WHAT/HOW/WHERE TO FILE |
TIME FRAMES |
ADDITIONAL RIGHTS |
||
Initial |
EmblemHealth Acknowledges Receipt |
EmblemHealth Determination Notification |
|||
HIP Commercial, |
Write to: EmblemHealth Telephone: |
60 business days from event. |
15 business days from the receipt of the request |
45 calendar days from receipt of all necessary |
May file a second level complaint. Additional complaint may be filed with the NYS DOH at any time by calling 1-800-206-8125. |
GHI HMO |
Write to: GHI HMO Telephone: TTY/TDD: 711 Fax to: |
90 calendar days from event. |
15 business days from the receipt of the request |
45 calendar days from receipt of all necessary |
May file a second level complaint. Additional complaint may be filed with the NYS DOH at any time by calling |
GHI and |
Write to: EmblemHealth/GHI Telephone: |
90 calendar days from event. |
15 business days from the receipt of the request |
45 calendar days from receipt of all necessary |
May file a second level complaint. |