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:

Initial 
Member Filing:

EmblemHealth Acknowledges Receipt:

EmblemHealth Determination Notification:

HIP Commercial,
HIP Child Health Plus

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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

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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

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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:

Initial Member Filing:

EmblemHealth Acknowledges Receipt:

EmblemHealth Determination Notification:

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.