Complaints and Appeals – Managed Care – New York State Department of Health

Enrollees and managed care providers may file a complaint with certain government agencies. Depending on the type of health care plan involved and the type of complaint, there are different agencies that can help. You do not have to file a complaint with your plan before you speak or write to a government office.

The office you contact may ask you to complete a form to file your complaint. If you file a verbal complaint, you may be required to submit written information or documents to support your complaint. If you designate someone to file the complaint for you, you may be required to sign a written authorization form to allow the government to share your personal health care information with the designated person.

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once all necessary information is received, the agency will review or investigate the complaint. the agency can work with the health plan to correct the problem and can check to see if any laws or regulations were broken. the agency will tell you how the complaint was resolved.

To file a complaint, find your issue in the box below and contact the government agency listed using the phone number, website, or mailing address provided.

• dissatisfaction with the quality of medical care
• difficulty getting dates
• references denied
• difficulty getting medical care or the type of doctor you need
• billing concerns or plan refusal to pay or a covered service
• termination problems
• care-related concerns
• access and availability
• questions or complaints related to mental health programs or services
• cost of the insurance policy
• questions about health care coverage
• complaint against any insurance company
• health-related consumer complaints
• consumer health care rights
• fraudulent, deceptive or misleading practices
• eligibility questions
• registration problems
• fair hearing request
• dissatisfaction with medical care
• difficulty getting needed medical care
• dissatisfaction with the workers’ compensation ppo
• late payments for part of a plan
• prompt payment law
• dissatisfaction with the quality of care in new york
• appeals and complaints
• benefit claims
• appeal information

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eastern new york and new york:

central and western new york:

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