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

Initial 
Member
Filing

EmblemHealth Acknowledges Receipt

EmblemHealth Determination Notification

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

Initial 
Member
Filing

EmblemHealth Acknowledges Receipt

EmblemHealth Determination Notification

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