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
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 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
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 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

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