Grievances and Appeals
Under 65 Members

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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.

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

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

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

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HARP Grievance and Appeals Rights

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

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Medicare Appeal Information

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

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EmblemHealth Plan, Inc. Hospital and Medical Claim Appeal Information

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

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HIP Claim Appeal Information

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

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NYS EmblemHealth Plan, Inc. Dental Claims Appeal Information

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

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

Member Rights and Responsibilities

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. 

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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.

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