Using the Grievance Process

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In an effort to serve our members in the best way possible, NHP strives to provide every opportunity to access NHP’s grievance process when dealing with difficult situations. We believe that honest and open communication with our members is the best way to resolve conflicts, however, in some instances, dialogue alone will not result in a resolution and the formal grievance process must be accessed. Therefore, we want to remind each of our members how to best access this channel of communication at NHP.

You or someone you name to act for you (your authorized representative) may file an appeal to us within 180 days from denial date of claim or denial date of coverage. If we continue to deny the payment, coverage, or service requested or you do not receive a timely decision, you may be able to request an external review of your claim by an independent third party, who will review the denial and issue a final decision. All appeal requests, including any supporting information, records, or documents must be submitted in writing to the following address:

Neighborhood Health Partnership,Inc.
A Unitedheatlhcare Company
Attention: Appeals Department
P.O. Box 5210
Kingston, NY 12402

Availability of Consumer Assistance/Ombudsman Services
In addition, there may be other resources available to help you understand the appeals process. For questions about your rights, this notice, or for assistance, you can contact the Employee Benefits Security Administration at 1-866-444-EBSA (3272). Additionally, a consumer assistance program may be able to assist you at the following:

Agency for Health Care Administration
Managed Care Unit
2727 Mahan Drive
Tallahassee, FL 32308
1-888-419-3456
www.AHCA.MyFlorida.com