New York

STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. By New York law, certified health plans must respond to complaints. Follow the steps below to file a complaint and appeal with your health plan:

• Call the member/customer service phone number for your health plan.
• tell them you want to file a formal complaint and then explain the problem.
• You can also file your complaint by letter, email, or online through your health plan’s website (see below).
• If you disagree with your health plan’s decision, you have the right to file an appeal.

Below are links to the complaint forms for New York’s top health plans:

• Aetna
• CareConnect
• Capital District Physicians’ Health Plan
• EmblemHealth
• Empire BlueCross BlueShield
• Independent Health
• MVP Health Care
• • Login to your member account or contact Customer Service.
• Northwell Health
• OSCAR
• UnitedHealthCare
  • Log on to MyUHC.com and complete the “Appeals and Grievance Form”
  • Select: Claims and Accounts > Medical Appeals and Grievances > Member Service Request Form
  • Fax or mail the completed form to the UnitedHealthcare address listed in the instructions
• My plan isn’t listed

Medicare Plans

 

STEP TWO – File a Complaint

You have the right to file a complaint with the New York State Department of Health if you have a problem getting the services you need, including quality and affordable health care.

• To file a complaint contact the Department by phone: (800) 206-8125.
• Find more information on how to file a complaint with the Department here.

To appeal your health plan’s decision to deny care, you can request an appeal with the New York State Department of Financial Services (DFS) after you complete your health plan’s appeal process.

• You must send an appeal application to DFS within four months of receiving your health plan’s decision to deny care.
• Complete the New York State External Appeal Application here.
• Find more information on how to complete the appeal application here.