Member Complaint - Second Level Process Tables

TABLE 21-4, SECOND LEVEL MEMBER 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 receipt of first level 
determination.

N/A

2 business days from receipt of necessary 
information.

Additional complaints 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

60 business days from receipt of first level 
determination.

N/A

2 business days from receipt of necessary 
information.

Additional complaints 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

60 business days from receipt of first level 
determination.

N/A

2 business days from receipt of necessary information.

Decision is final.

 

TABLE 21-5, SECOND 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 receipt of first level 
determination.

15 business days from receipt of the request.

30 business days from receipt of all necessary 
information.

Additional complaints 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

60 business days from receipt of first level 
determination.

15 business days from receipt of the request.

30 business days from receipt of all necessary 
information.

Additional complaints 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

60 business days from receipt of first level 
determination.

15 business days from receipt of the request.

30 business days from receipt of all necessary 
information.

Decision is final.

Chapter 32 Dispute Resolution for Commercial and CHP Plans