Table 21-1, Practitioner Complaint/Grievance Procedure

COMMERCIAL AND CHILD HEALTH PLUS PLANS

BENEFIT PLAN(S)

WHAT/HOW/WHERE TO FILE HARD COPY**

TIME FRAMES*

ADDITIONAL RIGHTS

Initial 
Practitioner Filing

EmblemHealth Acknowledges Receipt

EmblemHealth Determination Notification

HIP 
Commercial,
HIP Child Health Plus and EmblemHealth CompreHealth EPO (Retired August 1, 2018)

Unless otherwise directed in the denial letter or Explanation of Payment (EOP), write to:

EmblemHealth
Grievance and Appeal Dept
PO Box 2844
New York, NY 10116-2844

Telephone:
1-800-447-8255

60 calendar days from event.

15 calendar days from receipt of the request.

Complaint: 30 calendar days from receipt of request.

Grievance: 45 
calendar days from receipt of request.

Decision is final.

GHI HMO

Unless otherwise directed in the denial letter or Explanation of Payment (EOP), write to:

GHI HMO
Appeals and Complaints Dept
PO Box 2807
New York, NY 10117-2807

Telephone:
1-877-244-4466

TDD: 1-877-208-7920

Fax to: 
1-845-340-3435

90 calendar days from event.

15 calendar days from receipt of the request.

Complaint: 30 calendar days from receipt of request.

Grievance: 45 
calendar days from receipt of request.

Decision is final.

GHI EPO/PPO and 
EmblemHealth EPO/PPO

Unless otherwise directed in the denial letter or Explanation of Payment (EOP), write to:

EmblemHealth/GHI
PO Box 2857
New York, NY 10116-2857

Telephone:
1-212-501-4444

90 calendar days from event.

15 calendar days from receipt of the request.

Complaint: 30 calendar days from receipt of request.

Grievance: 45 
calendar days from receipt of request.

Decision is final.

*Privacy complaints are not subject to the above timeframes.

** Emblemhealth.com is the preferred method for filing.

Chapter 32 Dispute Resolution for Commercial and CHP Plans