Grievances & Appeals

Care that benefits you

Group 372

Unlimited Access

When you enroll in this the Hamaspik Choice Managed Long Term Care (MLTC) plan, you have access to home- and community-based, long-term care that keeps you living your best life.

Group 373

Vast Network

Our provider network includes home- and community-based support for those that need long-term care. The network features many of New York’s leading long-term care providers and their affiliated doctors.

Group 375

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, complaint, or as an appeal. You can file a grievance or complaint in writing, over the phone, via fax or email. You can find detailed information about grievances and appeals in your Member Handbook.

Group 225-2

Hamaspik Choice

Attn: Grievances and Appeals
775 N Main St.
Spring Valley, NY 10977
Group 224-2

Fax: 1-845-503-0999

Group 223-2

For TTY/TDD services, call 711

You can also file grievances with DOH by calling 1-866-712-7197

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 72 hours for expedited grievances). If we do not agree with some or all of your complaint or choose to dispute the issue, we will notify you. Our response will include reasons for this answer.

You will be informed on how to appeal a decision and will be provided any necessary forms. If we are unable to make a decision about your complaint due to missing information, we will also notify you.


If you are still dissatisfied after we review your grievance, you may file a grievance appeal. Please see your member handbook for more information about this.

Service authorizations

Hamaspik Choice makes a service authorization 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. You may also appeal this determination.

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 complaint is made in writing (even if you initially call, you must follow up in writing)

Your first level appeal is reviewed by Hamaspik Choice.  If our decision about your appeal is not totally in your favor, you have the right to request a Fair Hearing.  A Fair Hearing is a second level appeal that is heard by an independent third party.  We will send you a notice that explains how this process works

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 with the New York State Department of Health by dialing 1- 866-712-7197.


If your service request has been denied, we also encourage you to contact Member Services. There are many times when a member may ask Hamaspik Choice to approve a treatment or service in the form of an exception request. To get approval, call 833-426-2774 or send your request in writing:


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

Participant Ombudsman

The Participant Ombudsman, called the Independent Consumer Advocacy Network (ICAN), is an independent organization that provides free ombudsman services to long term care recipients in the state of New York. You can get free independent advice about your coverage, complaints, and appeal options. They can help you manage the appeal process.


They can also provide support before you enroll in a MLTC plan like Hamaspik Choice. This support includes unbiased health plan choice counseling and general program related information.


Contact ICAN to learn more about their services

Phone: 1-844-614-8800 (TTY users, please call: 711)

Getting help

For assistance with filing a coverage decision or grievance or appeal,

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 via the Appointment or Representative form on our

resources page.

We never stop caring for you

For assistance with any of the following,
contact our dedicated member service team 1-855-552-4642, For TTY/TDD services, call 711,
Monday-Friday 9AM-5PM.
Understanding your health plan coverage
Resolving a concern about your services
Finding a Provider
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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