Prescription Drugs
Grievances & Appeals

Care that benefits you

Group 375

Unlimited Access

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

Group 376

Vast Network

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

Group 377

Financial Support

As a member of Hamaspik Medicare Select, you may be eligible for extra help in the form of a Low Income Subsidy, which helps you pay for your prescription drugs and copayments. All people with Medicaid receive LIS.

Regardless of your income, all members receive the same high quality of care provided through our plan. However, you must continue to pay your Part B premium.

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.

Learn More
Group 378

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 Evidence of Coverage document.

Group 223

For TTY/TDD services, call 711

Group 225

Hamaspik Medicare Select


Attn: Grievances and Appeals
775 N Main St.
Spring Valley, NY 10977
Group 157

Group 224

Fax: 1-845-503-0999

You can also file grievances with CMS by calling 1-800-MEDICARE, or online at

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). If we choose to contest your complaint, you will be notified. Our response will include reasons for our course of action.

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.

Coverage decisions

Hamaspik Medicare Select makes a coverage decision every time we decide what services are covered and how much we will pay. 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.

Coverage decisions are only made by qualified physicians. When we make a coverage decision about your Medicare-covered services, we look at several important factors. First, we review the information submitted by you or your provider to confirm the service you are requesting is appropriate for somebody based you your diagnoses or other medical criteria. We also need to ensure that your services are approved for as long as they are medically necessary to avoid disruptions in your care. We make coverage decisions based on Medicare laws and guidelines, national coverage determinations (NCD), and local coverage determinations (LCD), when available. If this type of information is not available, we utilize Interqual clinical criteria to assist in our decision making. However, please note that the clinical criteria are used for guidance only; coverage decisions are always made by a physician. (Click here to learn more about Interqual clinical criteria.)

If you wish to request approval for a drug that is not included in the Hamaspik Medicare Select formulary, this is called an "exception request." Your doctor will need to provide us with information about why you need to take the drug 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 Medicare Select
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 referred to as a Level 1 appeal, and is reviewed by Hamaspik Medicare Select. If we deny your appeal, you may ask for a Level 2 appeal, which is reviewed by an independent third party. In some circumstances, other levels of appeal are also available.

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, including requests for Part D prescription drugs. Alternatively, you may appoint a friend, relative or another representative via the Appointment or Representative form on our

resources page.

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 Medicare by calling 1-800-MEDICARE or 1-800-633-4227. Or you can file your grievance with Medicare on-line by visiting

If your service request has been denied, 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 Medicare Select
Attn: Care Management
58 Route 59, Suite 1
Monsey, NY 10952

Notice of Non-Discrimination

Hamaspik Medicare Select complies with federal civil rights laws and does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. We also provide the following:


  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats and more)
  • Free language translation services to people whose first language is not English, such as qualified interpreters and information written in other languages

If you need services, contact Member Services. Or, if you believe Hamaspik has not given you these services or has treated you differently for any reason, you can file a grievance with Hamaspik:


In person: at the address listed above


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


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


Fax: 1-845-503-0999



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


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



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,
Oct 1 - Mar 31, Mon - Sun, 8AM - 8PM
Apr 1 - Sept 31, 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.

You are
Now leaving
this site

I want to stay