If you are dissatisfied with your plan or any of its employees, providers, or contractors, or your plan´s services, determination of benefits, or the health care treatment received through the plan, you can file a complaint or grievance with your plan. You may make your complaint/grievance verbally or in writing. You may also designate someone to make the complaint/grievance for you.
Refer to your member handbook to learn how to use the plan´s complaint/grievance process or call the plan´s member services or complaint/grievance phone line listed on your health plan identification card. Managed care plans certified by the Department of Health must have a process to receive and respond to complaints and grievances. Many issues can be resolved with a phone call to your plan.
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Managed care enrollees and providers can file a complaint with certain government agencies. Depending on the type of health care plan involved and the kind of complaint, there are different agencies that can help. You do not have to file a complaint with your plan before you speak with or write to a government office.
The office you contact may ask you to complete a form to file your complaint. If you make a verbal complaint, you may be asked to send written information or documents to support your complaint. If you designate someone to make the complaint for you, you may be asked to sign a written authorization form to allow the government to share your personal health care information with your designee.
Once all needed information is received, the agency will review or investigate the complaint. The agency may work with the health care plan to correct the problem, and may check if any laws or regulations were violated. The agency will inform you of how the complaint was resolved.
To file a complaint, find your issue on the chart below and contact the government agency listed through the phone number, web site or mailing address provided.
Who | Issue | Call | Write |
---|---|---|---|
Anyone enrolled in a NYS certified MCO (not behavioral health services) |
| 1–800–206–8125 | NYS Department of Health Managed Care Complaint Unit OHIP DHPCO 1CP–1609 Albany, New York 12237 Or Email: managedcarecomplaint@health.ny.gov |
Anyone enrolled in a NYS certified MCO with questions or comments related to behavioral health managed care |
| 1–800–597–8481 | NYS Department of Health Email: NYSDOH.BCS.Behavioral.Health.Complaints@health.ny.gov |
Anyone |
| 1–800–342–3736 New York City: 1–212–480–6400 | Consumer Assistance Unit NYS Department of Financial Services One Commerce Plaza Albany, NY 12210 |
Anyone |
| 1–800–428–9071 | NYS Office of the Attorney General – Health Care Bureau The Capitol Albany, NY 12224-0341 Fax: (518) 650–9365 |
NY Medicaid managed care enrollee |
| Local Department of Social Services or NY Health OPTIONS 1–855–693–6765 | Local Department of Social Services |
NY Medicaid managed care enrollee |
| 1–800–342–3334 | Fair Hearing Section NYS Office of Temporary and Disability Assistance Managed Care Hearing Unit PO Box 22023 Albany, NY 12201–2023 Fax: (518) 473–6735 |
Anyone enrolled in a NY Managed Long Term Care |
| 1–866–712–7197 | NYS Department of Health Bureau of Managed Long Term Care Suite 1620, One Commerce Plaza 99 Washington Ave. Albany, NY 12210 |
Anyone receiving services from a Workers´ Compensation PPO |
| 1–518–474–5515 | NYS Department of Health Workers´ Compensation Programs Room 1609, One Commerce Plaza 99 Washington Ave. Albany, NY 12210 |
NY health care providers |
| NYS Department of Financial Services | NYS Department of Financial Services One Commerce Plaza Albany, NY 12210 |
Medicare recipients |
| 1–866–334–9866 | Centers for Medicare and Medicaid Services Division of Medicare Health Plans Operations 26 Federal Plaza, Room 3810 New York, NY 10278 |
Anyone enrolled in a self–insured/ ERISA plan or through COBRA |
| 1–866–444–3272 | Eastern NY and NYC: Employee Benefits Security AdministrationU.S. Department of Labor New York Regional Office 33 Whitehall Street, Suite 1200 New York, NY 10004 Central and Western NY: Employee Benefits Security AdministrationU.S. Department of Labor Boston Regional Office J.F.K. Federal Building, Room 575 Boston, MA 02203 |
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Here is a list of items that you'll need:
Changing table supplies
Rocking chair with a footstool
Clothes for new baby
General items
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