We're committed to taking care of our members.
And your health is only part of it.
Along with providing you with the health care coverage you need, we take pride in making sure you have a good experience when you are using your benefits. Our goal is to provide you with excellent customer service, answer your questions, and always treat you with respect. That's the EmblemHealth difference. The following questions and answers provide excellent information about our commitment to customer service. If you have questions that aren't addressed here, we encourage you to call Customer Service at 1-800-447-8255 or visit emblemhealth.com, a great source for tools and getting answers to your questions.
What if I have questions about my plan?
If you have HIP Family Health Plus, HIP Medicaid Managed Care or HIP Child Health Plus, please call our Customer Service department at 1-800-447-8255. Our staff is available during business hours, and our automated service is available 24 hours a day, 7 days a week. You may also log in to myEmblemHealth, 24 hours a day, 7 days a week to:
- Review the most up-to-date listing of network doctors and other providers
- Select or change your PCP
- Request a replacement ID card
- View your benefits
- Change your PIN
- Read member newsletters
- View frequently asked questions
- Get preventive health information
How can I find out who my dentist is?
Healthplex is the company we contract with to provide dental services to our members in HIP's Medicaid, Child Health Plus and Family Health Plus programs. You and other enrolled family members are assigned to one of our network primary care dentists as of your effective date of enrollment. The name, address and telephone number of your dentist is included in your New Member Welcome Kit. If you do not know who your dentist is, or you want to change your dentist, please call Healthplex at 1-800-468-9868 between 8 am and 6 pm, Monday through Friday.
I just received a bill from a doctor. It says that HIP did not pay the full amount of the bill and that I must pay the balance. What should I do?
If a service provider sends you a bill for covered benefits because HIP denied or did not pay the full amount of the bill, call Customer Service at 1-800-447-8255 right away. We will call the provider on your behalf and resolve the situation.
I just received a HIP ID card showing that I'm enrolled in Family Health Plus. I used to have HIP Medicaid Managed Care. Why did my coverage change?
You can be moved from one program to another because of a change in eligibility. You can be moved from Medicaid Managed Care to Family Health Plus. Or you can be moved from Family Health Plus to Medicaid.
In the case shown above, your local Department of Social Services (LDSS) received your recertification application and found that you are no longer eligible for Medicaid, but that you are eligible for Family Health Plus instead. As a result, your LDSS disenrolled you from Medicaid and enrolled you in FHPlus. When we received this information from your LDSS, we updated your enrollment file.
If you change programs as shown above, you will also receive a New Member Welcome Kit with your Member Handbook. Please take some time to read your handbook, as some of your benefits will have changed. After a change in program, if you do not receive your New Member Welcome Kit or have other questions about this change, call Customer Service at 1-800-447-8255, Monday through Friday, 8 am to 6 pm.
How can I make a complaint about a hospital, doctor or dentist?
You may contact HIP about a complaint in one of three ways: by phone, in writing or in person.
- 1-888-447-2863, TTY for hearing impaired and deaf members/applicants: 1-877-444-2786
- Customer Service staff are available to help you Monday through Friday, 8 am to 6 pm. At other times, leave information on the answering machine. Make sure to give enough detail for us to understand your problem. We will return your call the next working day.
You can write us a letter and mail it to:
HIP Health Plan of New York
Grievance and Appeals Department
P.O. Box 2844
New York, NY 10016-2844
HIP Health Plan of New York
Customer Service Member Access Unit
55 Water Street (Entrance on Old Slip)
New York, NY 10041-8190
The Member Access Unit is wheelchair-accessible and open Monday through Friday, 8:30 am to 5 pm. No appointment is necessary.
How can I report a fraud?
Call the Fraud Abuse Hotline at 1-888-4-KO-FRAUD to report any suspected fraud or abuse. All calls are kept private. A representative will look into the reason for your call.