Benefits
Prescription Drugs
Resources
Grievances & Appeals

Care that benefits you

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Unlimited Access

When you enroll in the Hamaspik Medicaid plan, you receive comprehensive Medicaid services, and have access to all of the doctors, healthcare professionals, medical groups, hospitals and healthcare facilities that are part of your plan’s network.

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Vast Network

Our provider network includes hundreds of physicians in every county within our service area, covering your primary care needs and all of your other health and behavioral needs. The network also features many of New York’s leading hospital systems and their affiliated doctors.

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Preventive Health Services

Hamaspik Medicaid covers a broad range of preventive care screenings and services for adults and children. To learn more about these services,

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Behavioral Health Services

With Hamaspik Medicaid, you are covered for a broad range of Medicaid services. Inpatient care, outpatient services, and home and community-based services are covered for both adults and children.

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Financial Support

As a member of Hamaspik Medicaid HMO, your services are provided at no cost to you. The only exception to this is your prescription drugs, which have a small co-payment. Co-payment amounts are as follows:

• $3.00 for non-preferred Brand Name Drugs;
• $1.00 for Generic Drugs and preferred Brand Name Drugs;
• $0.50 for Non-Prescription (Over the Counter) Drugs.

Quality assurance is ensured

Hamaspik has programs in place to ensure our members always receive safe, appropriate care. We are committed to providing the highest caliber of healthcare services; therefore, we have created a Quality Improvement program aimed at maintaining this focus.

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Problem with your coverage?

If you have a concern about your healthcare or would like to file a complaint about your Hamaspik plan, please contact Member Services within 60 days of the problem. We want to understand your concerns and help you to resolve them. Depending on the situation, your case will be handled as a grievance, or as an appeal. You can file a grievance in writing, over the phone, via fax or email. You can find detailed information about grievances and appeals in your Member Handbook.

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1-888-426-2774
For TTY/TDD services, call 711

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Hamaspik Medicaid
Attn: Grievances and Appeals
58 Route 59, Suite 1
Monsey, NY 10952

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quality@hamaspik.com

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Fax: 1-845-503-0999

You can also file grievances with The New York State Department of Health (DOH) by calling
1-800-206-8125
 
Please contact Member Services if you would like to obtain information about the aggregate number of grievances, appeals and exceptions that have been filed with your Hamaspik healthcare plan.
 

What to expect

After you file a grievance, Hamaspik looks carefully into your case and will seek to resolve the problem right away. We will respond with the following:

 

  • The person who is working on your complaint
  • The contact information for this individual
  • Any additional information we will need to investigate your complaint

 

The next steps

We will investigate your concern, and will notify you of our decision within 30 days. (or within 24 hours for expedited grievances). We will send you a letter that explains the results of our investigation, and it will include reasons for our course of action.

You will be informed on how to appeal a decision if you disagree with our findings. If we are unable to make a decision about your complaint due to missing information, we will also notify you.

Coverage decisions

Hamaspik Medicaid makes a coverage decision every time we decide what services are covered. You or your doctor can also contact us to request a coverage decision if you are unsure if a particular medical service is included in your plan, or if the service that you want to request requires a prior authorization. Your doctor may need to provide us with information about why you need to receive the service that you are requesting.

 

You may also appeal any coverage determination, if you disagree with our decision.

 

If you have a question about how to ask for a service to be authorized, or how to file an appeal, we also encourage you to contact Member Services.

 

Please call 888-426-2774. (TTY users, call 711.)
Or send your request in writing to:
 

Hamaspik Medicaid
58 Route 59, Suite #1
Monsey, NY 10952

How to appeal

To appeal a decision about your health care services, please follow these guidelines:

 

  • File an appeal within 60 business days of receiving our decision
  • File the appeal yourself or ask someone you trust to file the complaint on your behalf
  • Make sure the appeal is made in writing (even if you initially call, you must follow up in writing)

Your first appeal is reviewed by Hamaspik Medicaid. A person who was not involved in the decision to deny or limit your coverage will review your appeal. If we deny your appeal, you may ask for a Level 2 appeal, which is also known as a “Fair Hearing.” The Fair Hearing is reviewed by an independent third party. In some circumstances, other levels of appeal are also available.

Alternative Options

If you are not satisfied with the services you have received from Hamaspik, you (or someone on your behalf) may submit a complaint directly to the New York State Department of Health (DOH) by calling 1-800-206-8125.


If your complaint or appeal is about your long term care services or your behavioral health services, you can call the Independent Consumer Advocacy Network (ICAN) to get free, independent advice about your coverage, complaints, and appeal options.  They can help you manage the appeal process. 

 

Contact ICAN to learn more about their services:

If your service request has been denied, we also encourage you to contact Member Services. Please call 1.888.426.2774 (TTY users, call 711); or send your request in writing to:

 

Hamaspik Medicaid
Attn: Care Management
58 Route 59, Suite #1
Monsey, NY 10952

Getting help

For assistance with filing a grievance, or a coverage decision or an appeal, please contact us. Your doctor, prescriber or lawyer can also submit a request on your behalf at any point in the appeals process. Alternatively, you may appoint a friend, relative or another representative to help you. If you request help from another individual, you will need to submit the Appointment or Representative form found on our resources page.

Notice of Non-Discrimination

Hamaspik Medicaid plan complies with Federal civil rights laws. Hamaspik, Inc. does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

 

Hamaspik, Inc. provides the following:

 

  • Free aids and services to people with disabilities to help you communicate with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Free language services to people whose first language is not English, such as:
    • Qualified interpreters
    • Information written in other languages
If you need these services, call Hamaspik, Inc. at 888-426-2774.
For TTY services, call 711.

 

If you believe that Hamaspik, Inc. has not given you these services or treated you differently because of race, color, national origin, age, disability, or sex, you can file a grievance with Hamaspik, Inc. by:

 

In person: at the address listed above

 

Mail: Hamaspik, Inc.
         Attention: Grievances and Appeals
         58 Route 59, Suite 1
         Monsey, NY 10952
 

 

Phone: 1-833-426-2774 For TTY/TDD services, call 711

 

Fax: 1-845-503-0999

 

Email: quality@hamaspik.com


You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights via:

 

Web: OCR Complaint Portal at

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

 

Mail: U.S. Department of Health and Human Services
200 Independence Avenue SW, Room 509F,
HHH Building
Washington, DC 20201

 

Complaint forms are available at

http://www.hhs.gov/ocr/office/file/index.html

 

Phone:

1-800-368-1019
For TTY/TDD, call 800-537-7697

We never stop caring for you

For assistance with any of the following,
contact our dedicated member service team 1-888-426-2774, For TTY/TDD services, call 711,
Mon - Fri, 8AM - 8PM.
Understanding your health plan coverage
Resolving a concern about your services
Finding a provider or changing your PCP
Replacing a lost Hamaspik ID card
Submitting concerns or positive feedback
Questions about plan enrollment
Getting enrollment status updates
… and more

Your resource for quality care

Get the care you need, the information you want,
and your questions answered—all here on our site.
 

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