Grievances and Appeals
Under 65 Members

Older woman with long hair on phone while looking at laptop

You have the right to file a grievance or complaint and appeal a decision made by us. Use the links below to review the appropriate appeal document, which presents important information on how to file, timeframes and additional resources.

Medicare Members: access grievance and appeals information here.

First Level Complaint Appeal Rights
Important information about your rights and how to file a complaint appeal.

Learn More

First Level Grievance Appeal Rights
Important information about your rights and how to file a grievance appeal.

Learn More

Final Level Grievance Appeal Rights
Important information about your completed final level of internal review and other resources to help you.

Learn More

Medicaid Grievance and Appeals Rights
Important information about your rights and other resources to help you.

Learn More

HARP Grievance and Appeals Rights

Important information about your rights and other resources to help you.

Learn More

Medicare Appeal Information

Important information about your rights and other resources to help you.

Learn More

EmblemHealth Plan, Inc. Hospital and Medical Claim Appeal Information

Important information about your rights and other resources to help you.

Learn More

HIP Claim Appeal Information

Important information about your rights and other resources to help you.

Learn More

NYS EmblemHealth Plan, Inc. Dental Claims Appeal Information

Important information about your rights and other resources to help you.

Learn More

 

If you have any questions or need help reading or understanding these documents, please call EmblemHealth Customer Service.

KNOW YOUR RIGHTS

Member Rights and Responsibilities

Understanding your rights and responsibilities as a plan member can help you and us make the most of your membership. 

Support

Consumer Protections

Learn about certain protections which are effective with dates of service on or after March 31, 2015, as well as what to do if you feel you have received a surprise bill.

HELP AND SUPPORT

Pharmacy Support

Search your plan formulary, find participating pharmacies, and access forms.

Pharmacist smiling at male customer.