A grievance is a complaint about any problem you have with Healthfirst Medicare Plan or our providers. It does not pertain to payment or approval of Plan benefits which are called organization determinations.
For example, you may complain about how long it takes to make an appointment or about the cleanliness of a provider’s office.
Monday through Friday, 8:30am-5:30pm
Healthfirst Medicare Plan
Appeals and Grievances Unit
P.O. Box 5166
New York, NY 10274-5166
If you have a complaint, contact us promptly. You have 60 days after the date of the event or incident to make your complaint.
Usually, calling Member Services at the number listed above is the first step. If there is anything else you need to do, Member Services will let you know. If you do not wish to call or if you called but were not satisfied with the response, you can put your complaint in writing and mail it to us.
We will answer your complaint either in writing or by telephone (or both) no more than 30 days after the day we receive your letter. If you ask us to, or if we need more than 30 days to respond to your complaint, we may take another 14 days to answer.
Your complaint may be about the amount of time we take to make an organization determination (also called a coverage decision). For example, if we extend the timeframe for reaching a coverage decision, you can file a fast complaint. We will respond by phone within 24 hours of receiving your complaint and follow up with a written explanation within 3 days. If you are making a complaint because we denied your request for a fast response to a coverage decision, we will automatically give you a fast complaint.
For further information, please refer to Chapter 9 of your Evidence of Coverage with links provided at the bottom of this page.