NYSID Guide to HMOs

Resources > HMO Member Rights | Your Right to Appeal | Who to Contact | Additional HMO Information

Who to Contact When You Have a Problem

If you have a problem with your health insurer, you should first contact your insurer’s Member Services Department to try to resolve it. If you cannot resolve the problem to your satisfaction, call the appropriate State agency listed below for assistance.

For issues concerning payment, reimbursement, coverage, benefits, rates and premiums, contact:

New York State Insurance Department
Consumer Services Bureau
One Commerce Plaza
Albany, NY 12257

1-800-358-9260 (prompt pay complaints)
1-800-342-3736 (coverage, benefits, rates and premiums)

If you have been denied coverage of health care services, review the section about appealing an insurer’s decision or call:

1-800-400-8882 (external reviews for denied coverage)

For issues concerning HMO Quality of Care, contact:

New York State Department of Health
Office of Managed Care
Bureau of Managed Care Certification and Surveillance-Complaint Unit
Corning Tower , Rm. 1911
Albany, NY 12237

1-800-206-8125 (quality of care)

Under federal law, if you receive health coverage through a self-insured plan (ERISA plan), New York consumer protections and insurance laws do not apply to self-insured plans (see page 2).

If you have a complaint regarding a self-insured plan, contact:

United States Department of Labor
200 Constitution Avenue, NW
Washington, DC 20210
866-4-USA-DOL (866-487-2365)

For issues concerning insurance fraud, contact:

NYSID Insurance Frauds Bureau
25 Beaver Street
New York NY 10004
888-FRAUDNY (888-372-8369)

Copyright © 2006 New York State Insurance Department