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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