Your Essential Plan complaints, grievances and appeals in New York

Complaints and grievances

If you have a problem or concern with your medical care or our services, you have the right to file a complaint. A complaint is the first part of the grievance process. Some examples of complaints and grievances are:

• You have a problem with the quality of your care.
• Wait times are too long.
• Your doctors or the doctor’s staff behave badly.
• You can’t reach someone by phone.
• You can’t get the information you need.
• A doctor’s office is not clean.
• You can’t find a doctor in your area.
• You can’t get your medicine.

Appeals

You can file an appeal when you do not agree with our decision to:

• Change, suspend, or reduce a service
• Stop or deny a service
• Deny payment for services provided

How to file a complaint, grievance or appeal:

You can file a complaint, grievance or appeal by:

• Phone. Call Molina Healthcare of New York and Affinity by Molina Healthcare Member Services at (800) 223-7242 (TTY/TDD: 711) Monday - Friday 8 a.m. - 6 p.m. local time. Call Senior Whole Health of New York NHC Medicaid Advantage Plan (MAP) (833) 671-0440 (TTY: 711) Monday - Friday 8 a.m. - 8 p.m. local time. Call Senior Whole Health of New York Managed Long-Term Care (MLTC) (877) 353-0185 (TTY: 711) Monday - Friday 8 a.m. - 8 p.m. local time.
• Mail. Fill out a grievance/complaint form or an appeal request form and mail it to:

                   Molina Healthcare of New York, Inc.

                   Attention: Member Services Department

                   2900 Exterior St., Suite 202

                   Bronx, NY 10463

• Fax. Fill out a grievance/complaint form  or an appeal request form and fax it to (718) 536-3358.

Be sure to include the following information:

• Your first and last name
• Your signature and the date
• Your date of birth
• Your member ID number (on the front of your member ID card)
• Your address and telephone number
• A description of the issue

If you wish to talk in your own language, a translator can help you file the request. This service is free to all members.

If you want a family member or your doctor to file the grievance or appeal for you, we need your written permission.

For more information, visit our complaints, grievances and appeals resource page or check your Member Handbook.

Molina Healthcare of New York

Affinity by Molina Healthcare