Member Grievance - Second Level Process Tables

TABLE 21-8, SECOND LEVEL MEMBER GRIEVANCE - 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	Unless otherwise directed in the denial letter, 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 written grievance determination.	N/A	Within two business days of receipt of necessary information but not to exceed 72 hours. Verbally at time of determination. Written notice is provided no later than two business days from receipt of all necessary information, or 72 hours from receipt of the grievance.	Additional complaints may be filed with the NYS DOH at any time by calling 800-206-8125.
GHI HMO	Unless otherwise directed in the denial letter, 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).	60 business days from receipt of written grievance determination.	N/A	Within two business days of receipt of necessary information but not to exceed 72 hours. Verbally at time of determination. Written notice is provided no later than two business days from receipt of all necessary information, or 72 hours from receipt of the grievance.	Additional complaints may be filed with the NYS DOH at any time by calling 800-206-8125.
EmblemHealth EPO/PPO	Unless otherwise directed in the denial letter, sign in to: emblemhealth.com and use My Messages under username drop-down. Write to: EmblemHealth P.O. Box 2844 New York, NY 10116 Telephone: 212-501-4444 (TTY: 711).	60 business days from receipt of written grievance determination.	N/A	Within two business days of receipt of necessary information but not to exceed 72 hours. Verbally at time of determination. Written notice is provided no later than two business days from receipt of all necessary information, or 72 hours from receipt of the grievance.	Decision is final.

TABLE 21-9, SECOND LEVEL MEMBER GRIEVANCE - 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 Practitioner Filing:	EmblemHealth Acknowledges Receipt:	EmblemHealth Determination Notification:	ADDITIONAL RIGHTS:
HIP Commercial, HIP Child Health Plus	Unless otherwise directed in the denial letter, 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 written grievance determination.	Pre-Service: Acknowledgement is not required if responded to within 15 calendar days. Post-Service: 15 calendar days from receipt of the grievance-appeal.	Pre-Service: 15 calendar days from receipt of grievance-appeal. Post-Service: 30 calendar days from receipt of grievance-appeal.	Additional complaints may be filed with the NYS DOH at any time by calling 800-206-8125.
GHI HMO	Unless otherwise directed in the denial letter, 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).	60 business days from receipt of written grievance determination.	Pre-Service: Acknowledgement is not required if responded to within 15 calendar days. Post-Service: 15 calendar days from receipt of the grievance-appeal.	Pre-Service: 15 calendar days from receipt of grievance-appeal. Post-Service: 30 calendar days from receipt of grievance-appeal.	Additional complaints may be filed with the NYS DOH at any time by calling 800-206-8125.
EmblemHealth EPO/PPO	Unless otherwise directed in the denial letter, 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: 877-842-3625 (TTY: 711).	60 business days from receipt of written grievance determination.	Pre-Service: Acknowledgement is not required if responded to within 15 calendar days. Post-Service: 15 calendar days from receipt of the grievance-appeal.	Pre-Service: 15 calendar days from receipt of grievance-appeal. Post-Service: 30 calendar days from receipt of grievance.	Decision is final.