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Table 23-1, Provider Complaint/Grievance Procedures

Switch to:

Table 23-1, Provider Complaint/Grievance Procedures

TABLE 23-1, PROVIDER COMPLAINT/GRIEVANCE PROCEDURES
EMBLEMHEALTH MEDICARE HMO AND PPO PLANS
BENEFIT PLAN(S):	WHAT/HOW/WHERE TO FILE HARD COPY:**	TIME FRAMES:*		ADDITIONAL RIGHTS:
BENEFIT PLAN(S):	WHAT/HOW/WHERE TO FILE HARD COPY:**	Initial Practitioner Filing:	EmblemHealth Determination Notification:	ADDITIONAL RIGHTS:
EmblemHealth Medicare HMO Plans	Sign in to emblemhealth.com/providers and use My Messages under username drop-down Write to: EmblemHealth Medicare HMO P.O. Box 2807 New York, NY 10116-2807	60 calendar days from event. Exceptions:SUNY Downstate - 90 calendar days from event; Stony Brook Affiliations - 120 calendar days from event.	Complaint: 30 calendar days from receipt of request. Grievance: 30 calendar days from receipt of request.	Decision is final.
EmblemHealth Medicare PPO Plans	Sign in to emblemhealth.com/providers and use My Messages under username drop-down Write to: EmblemHealth Medicare PPO P.O. Box 2807 New York, NY 10116-2807	60 calendar days from event.	Complaint: 30 calendar days from receipt of request. Grievance: 30 calendar days from receipt of request.	Decision is final.

* Contracted facility time frames in provider agreements will supersede time frames in this manual.

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

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.