COMMERCIAL AND CHILD HEALTH PLUS PLANS |
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BENEFIT PLAN(S) |
WHAT/HOW/WHERE TO FILE HARD COPY** |
TIME FRAMES* |
ADDITIONAL RIGHTS |
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Initial |
EmblemHealth Acknowledges Receipt |
EmblemHealth Determination Notification |
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HIP |
Unless otherwise directed in the denial letter or Explanation of Payment (EOP), write to: EmblemHealth Telephone: |
60 calendar days from event. |
15 calendar days from receipt of the request. |
Complaint: 30 calendar days from receipt of request. Grievance: 45 |
Decision is final. |
GHI HMO |
Unless otherwise directed in the denial letter or Explanation of Payment (EOP), write to: GHI HMO Telephone: TDD: 1-877-208-7920 Fax to: |
90 calendar days from event. |
15 calendar days from receipt of the request. |
Complaint: 30 calendar days from receipt of request. Grievance: 45 |
Decision is final. |
GHI EPO/PPO and |
Unless otherwise directed in the denial letter or Explanation of Payment (EOP), write to: EmblemHealth/GHI Telephone: |
90 calendar days from event. |
15 calendar days from receipt of the request. |
Complaint: 30 calendar days from receipt of request. Grievance: 45 |
Decision is final. |
*Privacy complaints are not subject to the above timeframes.
** Emblemhealth.com is the preferred method for filing.