Atlantis Health Plan members Find a Physician Home
News/Events
Company Info
Contact Us
Site Map
Members Links
Member Handbook
New PCP Request
Member Handbook POS
Products
  Healthy New York
  Benefit Summaries
  Riders
  Rx Plans
Member FAQ
Member Newsletter
HIPAA Information
Forms
Contact Us

Atlantis Outpatient Centers


<< Back to table of contents

Member Complaints and Grievances

Members of Atlantis Health Plan have the right to file a complaint or grievance regarding any aspect of the Plan or services provided by Atlantis or the Planís providers.

All disputes involving clinical decisions will be made by qualified clinical personnel. All notices of determination will include information about the basis of the decision and further appeal rights, if any.

Members have the right to designate a representative to file complaints and appeals on their behalf.

The Plan will not retaliate or take any discriminatory action against a Member because a complaint or appeal has been filed.

The MEMBER HANDBOOK provides a complete description of the Grievance Procedure that will be used to resolve disputes, to include:

Your right to file a grievance regarding any dispute:

∑ Your right to file a grievance orally when the dispute is about referrals or covered benefits;

∑ The toll-free telephone number which Members may use to file an oral grievance;

∑ The timeframes and circumstances for expedited and standard grievances;

Your right to appeal a grievance determination:

∑ The procedures for filing such an appeal;

∑ The timeframes and circumstances for expedited and standard appeals.

Please thoroughly review the Grievance Procedure section of the MEMBER HANDBOOK to understand your rights.

<< Back to table of contents