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Member Complaint - First Level Process Tables

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Member Complaint - First Level Process Tables

TABLE 21-2, FIRST LEVEL MEMBER COMPLAINT - EXPEDITED
COMMERCIAL AND CHILD HEALTH PLUS PLANS
BENEFIT PLAN(S):	WHAT/HOW/WHERE TO FILE INSTRUCTIONS:	TIME FRAMES:			ADDITIONAL RIGHTS:
BENEFIT PLAN(S):	WHAT/HOW/WHERE TO FILE INSTRUCTIONS:	Initial Member Filing.	EmblemHealth Acknowledges Receipt.	EmblemHealth Determination Notification.	ADDITIONAL RIGHTS:
HIP Commercial, HIP Child Health Plus	Sign in to: emblemhealth.com and use My Messages under username drop-down. Write to: EmblemHealth Grievance and Appeal Dept P.O. Box 2844 New York, NY 10116-2844 Telephone: 800-447-8255 (TTY: 711).	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 800-206-8125.
GHI HMO	Sign in to: emblemhealth.com and use My Messages under username drop-down. Write to: GHI HMO Appeals and Complaints Dept P.O. Box 22844 New York, NY 10116-2844 Telephone: 877-244-4466 (TTY: 711). Fax to: 845-340-3435	60 calendar days from event.	N/A	Verbal response within 48 hours of receipt of necessary information. Written notice sent within three 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 800-206-8125.
EmblemHealth EPO/PPO	Sign in to: emblemhealth.com and use My Messages under username drop-down. Write to: EmblemHealth P.O. Box 2844 New York, NY 10116-2844 Telephone: 212-501-4444 (TTY: 711).	60 calendar days from event.	N/A	Verbal response within 48 hours of receipt of necessary information Written notice sent within three business .	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 INSTRUCTIONS:	TIME FRAMES			ADDITIONAL RIGHTS:
BENEFIT PLAN(S):	WHAT/HOW/WHERE TO FILE INSTRUCTIONS:	Initial Member Filing:	EmblemHealth Acknowledges Receipt:	EmblemHealth Determination Notification:	ADDITIONAL RIGHTS:
HIP Commercial,HIP Child Health Plus	Sign in to: emblemhealth.com and use My Messages under username drop-down. Write to: EmblemHealth Grievance and Appeal Dept P.O. Box 2844 New York, NY 10116-2844 Telephone: 800-447-8255 (TTY: 711).	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 800-206-8125.
GHI HMO	Sign in to: emblemhealth.com and use My Messages under username drop-down. Write to: GHI HMO Appeals and Complaints Dept P.O. Box 2844 New York, NY 10116-2844 Telephone: 877-244-4466 (TTY: 711) Fax to: 845-340-3435	60 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 800-206-8125.
EmblemHealth EPO/PPO	Sign in to: emblemhealth.com and use My Messages under username drop-down Write to: EmblemHealth P.O. Box 2844 New York, NY 10116-2844 Telephone: 212-501-4444 (TTY: 711).	60 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.

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

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.