Report a Problem
Is there a problem?
We hope our health plan serves you well. If you have a problem, talk with your Primary Care Professional (PCP), or call or write to Customer Care. Most problems can be solved right away. If you have a problem or dispute with your care or services, you can file a complaint with us. Problems that are not solved right away on the phone, and any complaints that come in the mail, will be handled according to the procedure described below.
You can ask someone you trust (such as a legal representative, a family member, or friend) to file the complaint for you. If you need our help because of a hearing or vision impairment, or if you need translation services, we can help you. We will not make things difficult for you or take any action against you for filing a complaint.
How to File a Complaint
You can file a complaint by telephone if we have been denied payment for a referral or we have told you a service is not covered. To file a complaint by phone, call Customer Care at 1.800.339.4557, Monday – Friday, 8:30 am – 5:00pm. If you call us after hours, leave a message. We will return your call the next workday. If we need more information to make a decision, we will tell you.
If needed, we will ask you to sign a written statement of your phone complaint. This puts the basic facts of your complaint on record and makes your concerns clear. After your call, we will send you a form that outlines your complaint. If you agree with our summary, you should sign and return the form to us. You can make any needed changes before returning the form to us.
You can also file a written complaint for other concerns by writing us a letter or submitting a complaint form. To obtain a complaint form by mail, call us at 1.800.339.4557. Fax your letter or complaint form to 1.914.524.7661, or mail it to:
Hudson Health Plan Customer Care Department
303 South Broadway, Suite 321
Tarrytown, NY 10591-5455
You also have the right to contact the New York State Department of Health about your complaint by calling New York, by calling your local Department of Social Services office, or writing to the New York State Department of Health, Bureau of Certification and Surveillance, Corning Tower, Albany, NY 12237-0062. You may call the New York State Insurance Department at 1.800.342.3736 if your complaint involves a billing problem.
What Happens Next?
After we receive your complaint, we will send you a letter within 15 workdays. We will tell you who is working on your complaint, how to contact this person, and if we need additional information.
Your complaint will be reviewed by one or more qualified people. If your complaint involves clinical matters, your case will be reviewed by one or more qualified health care professionals.
After we have reviewed your complaint, we will let you know our decision in 45 days once we have all the information we need to answer your complaint, but you will hear from us in no more than 60 days from the day we get your complaint. We will write you and give you the reasons for our decision.
When a delay would put your health at risk, we will let you know our decision within 48 hours once we have all the information we need to answer your complaint, but you will hear from us in no more than seven days from the day we get your complaint. We will call you with our decision, and you will receive a letter to follow-up our communication in three workdays. We will tell you how to appeal our decision if you are not satisfied and we will include any forms you may need.
We will send you a letter and let you know if we are unable to make a decision about your complaint because we do not have enough information.
Complaint Appeals
If you are not satisfied with what we decide, you have at least 60 workdays after hearing from us to file a complaint appeal. You can do this yourself or ask someone you trust to file the appeal for you. The appeal must be in writing. You can write a letter or use the Plan’s complaint form, contact Customer Care or call 1.800.339.4557 for help.
We will send you a letter within 15 workdays. This letter will tell you who is working on your appeal, how to contact that person, and if we need additional information.
Your complaint appeal will be decided these ways:
Appeals on clinical matters will be decided by qualified health care professionals who did not work on your original complaint. All other appeals that are not about clinical matters will be decided by people who work for our Plan at a higher level than those who worked on your original complaint.
After we get all the information we need, we will let you know our decision within 30 workdays. If a delay would risk your health you will get our decision within two workdays of when we have all the information we need to decide the appeal. We will give you the reasons for our decision and the medical explanation, if it applies. If you are still not satisfied, you or someone on your behalf can file a complaint with the New York State Department of Health at 1.800.206.8125.