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Member Complaint - Second Level Process Tables

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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 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 receipt of first level determination.	N/A	Two business days from receipt of necessary information.	Additional complaints 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 business days from receipt of first level determination.	N/A	Two business days from receipt of necessary information.	Additional complaints 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 business days from receipt of first level determination.	N/A	Two 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 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 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 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 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 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 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.