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 |
EmblemHealth Acknowledges Receipt: |
EmblemHealth Determination Notification: |
|||
HIP Commercial, |
Sign in to: emblemhealth.com and use My Messages under username drop-down. Write to: EmblemHealth Telephone: |
60 business days from receipt of first level |
N/A |
Two business days from receipt of necessary |
Additional complaints may be filed with the NYS DOH at any time by calling |
GHI HMO |
Sign in to: emblemhealth.com and use My Messages under username drop-down. Write to: GHI HMO Telephone: Fax to: |
60 business days from receipt of first level |
N/A |
Two business days from receipt of necessary |
Additional complaints may be filed with the NYS DOH at any time by calling |
EmblemHealth EPO/PPO |
Sign in to: emblemhealth.com and use My Messages under username drop-down. Write to: EmblemHealth Telephone: |
60 business days from receipt of first level |
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, |
Sign in to: emblemhealth.com and use My Messages under username drop-down. Write to: EmblemHealth Telephone:
|
60 business days from receipt of first level |
15 business days from receipt of the request. |
30 business days from receipt of all necessary |
Additional complaints may be filed with the NYS DOH at any time by calling |
GHI HMO |
Sign in to: emblemhealth.com and use My Messages under username drop-down. Write to: GHI HMO Telephone: Fax to: |
60 business days from receipt of first level |
15 business days from receipt of the request. |
30 business days from receipt of all necessary |
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 Telephone: |
60 business days from receipt of first level |
15 business days from receipt of the request. |
30 business days from receipt of all necessary |
Decision is final. |