Member Complaint - First Level Process Tables

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
BENEFIT PLAN(S)	WHAT/HOW/WHERE TO FILE	Initial Member Filing	EmblemHealth Acknowledges Receipt	EmblemHealth Determination Notification	ADDITIONAL RIGHTS
HIP Commercial, HIP Child Health Plus and EmblemHealth CompreHealth EPO (Retired August 1, 2018)	Write to: EmblemHealth Grievance and Appeal Dept PO Box 2844 New York, NY 10116-2844 Telephone: 1-800-447-8255	60 business days from event.	N/A	Verbal response within 48 hours of receipt of necessary information. Written notice sent within 3 business days of determination	May file a second level complaint, expedited or standard. Additional complaint may be filed with the NYS DOH at any time by calling 1-800-206-8125.
GHI HMO	Write to: GHI HMO Appeals and Complaints Dept PO Box 2807 New York, NY 10117-2807 Telephone: 1-877-244-4466 TTY/TDD: 711 Fax to: 1-845-340-3435	90 calendar days from event.	N/A	Verbal response within 48 hours of receipt of necessary information. Written notice sent within 3 business days of determination.	May file a second level complaint, expedited or standard Additional complaint may be filed with the NYS DOH at any time by calling 1-800-206-8125.
GHI and EmblemHealth EPO/PPO	Write to: EmblemHealth/GHI PO Box 2857 New York, NY 10116 Telephone: 1-212-501-4444	90 calendar days from event.	N/A	Verbal response within 48 hours of receipt of necessary information Written notice sent within 3 business days of determination.	May file a second level complaint, expedited or standard.

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
BENEFIT PLAN(S)	WHAT/HOW/WHERE TO FILE	Initial Member Filing	EmblemHealth Acknowledges Receipt	EmblemHealth Determination Notification	ADDITIONAL RIGHTS
HIP Commercial, HIP Child Health Plus and EmblemHealth CompreHealth EPO (Retired August 1, 2018)	Write to: EmblemHealth Grievance and Appeal Dept PO Box 2844 New York, NY 10116-2844 Telephone: 1-800-447-8255	60 business days from event.	15 business days from the receipt of the request	45 calendar days from receipt of all necessary information.	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 Appeals and Complaints Dept PO Box 2807 New York, NY 10117-2807 Telephone: 1-877-244-4466 TTY/TDD: 711 Fax to: 1-845-340-3435	90 calendar days from event.	15 business days from the receipt of the request	45 calendar days from receipt of all necessary information.	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 and EmblemHealth EPO/PPO	Write to: EmblemHealth/GHI PO Box 2857 New York, NY 10116 Telephone: 1-212-501-4444	90 calendar days from event.	15 business days from the receipt of the request	45 calendar days from receipt of all necessary information.	May file a second level complaint.

Chapter 32 Dispute Resolution for Commercial and CHP Plans

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Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.