Elderplan Customer Service — Professional Guide for Members

Overview and what customer service handles

Elderplan customer service is the primary resource for members who need help with benefits, billing, prior authorizations, provider networks, pharmacy coverage, and filing grievances or appeals. As a Medicare Advantage/SNP carrier operating in New York, Elderplan’s member services teams are trained to interpret plan-specific benefits (monthly premiums, copays, pharmacy tiers) and to act as the front line for both routine questions and urgent access-to-care problems. In practice this means the team will verify eligibility, explain covered services, initiate prior authorization requests to clinical teams, and forward urgent medical access concerns for expedited review.

Typical volume data for plans this size shows that timely response and clear escalation paths reduce formal grievances by 30–50% year over year when proactively managed; members who use phone plus secure online portals report faster resolution and higher satisfaction. Keep in mind that your member ID card is the single most important document for customer service interactions — it contains your plan number, the exact phone number you should call, your member ID, and any special program identifiers (e.g., SNP status, dual-eligibility) that change how a case is handled.

How to contact Elderplan and when to use each channel

There are four practical channels to contact Elderplan: phone (member services), secure member portal or mobile app, written correspondence (mail), and in-person or community outreach events. Use the phone for time-sensitive issues (authorization delays, billing disputes, urgent network questions). Use the secure portal or app for submitting non-urgent documents (drug prior auth forms, records), tracking a case, and reviewing Explanation of Benefits (EOBs). Written letters are recommended for formal grievances or appeals to create an auditable trail.

• Phone: Check your member ID card for the exact member services number; for Medicare general issues use 1-800-MEDICARE (1-800-633-4227). If you need TTY access, call the national Medicare TTY line at 1-877-486-2048 to request assistance and referral to your plan’s TTY number.
• Online: Visit the official plan website to log into the secure member portal — search for “Elderplan member portal” from a browser. Portals typically show claims status, upcoming authorizations, and secure messaging. Hours for live phone support are commonly 8:00 AM–8:00 PM local time Monday–Friday, with limited weekend coverage; verify current hours on your portal or ID card.
• Mail: Send formal grievances or appeals to the plan’s Grievance & Appeals department (address listed on member materials). Always send by certified mail and keep copies of all documents.

What to prepare before you call — documents, questions, and priorities

Prepare the following so customer service can act immediately: your member ID number, date of birth, the provider’s name and NPI (if available), exact dates of service or the prescription name and NDC code, claim or authorization reference numbers, and copies of relevant EOBs or denial letters. Having these details shortens call times and reduces handoffs; agents typically open a case within the first 5–10 minutes if documentation is available.

• Documents checklist: member ID card, photo ID, recent EOB or denial notice, provider referral or prescription details, and any medical records pertinent to the request. If you plan to authorize a caregiver or family member to act on your behalf, bring a signed Authorization for Release of Information or a Power of Attorney document as applicable.

Common issues, expected timelines, and escalation

Common member issues include network/provider changes, claim denials, prior authorization delays, pharmacy formulary questions, and billing or secondary insurance coordination. For non-urgent prior authorization and coverage determinations, Medicare rules require a timely organization decision; in practice, many plans aim to resolve standard requests within 14 calendar days and expedited requests within 72 hours — confirm with your plan’s member services for specific internal SLAs. Pharmacy prior authorizations and step-therapy exceptions often have tighter internal targets; expect initial responses within 24–72 hours for pharmacy-related expedited requests.

If a problem isn’t resolved on the first call, ask the agent for a case or reference number and the name and ID of the person handling your file. Escalate to a supervisor if you do not receive a status update within the timeframe quoted. For formal escalation beyond the plan, members can contact Medicare at 1-800-MEDICARE, consult their local State Health Insurance Assistance Program (SHIP) for free counseling, or file a complaint with the New York State Department of Health or Department of Financial Services depending on the issue.

Grievances, appeals and legal rights

If you receive an adverse determination (denial of service or payment), you have the right to file a grievance or an appeal. Start by submitting a written appeal to Elderplan’s Appeals department using the address or secure portal instructions on your member materials. Keep detailed records of timelines: appeal submissions, phone calls (date, time, representative), and receipts for certified mail. Federal Medicare timelines generally allow plans 14 calendar days for standard organization determinations and 72 hours for expedited cases; after the plan denies an appeal, you may have the right to request an Independent Review Entity (IRE) or continue the process through the Medicare appeals cascade.

Costs for filing appeals are generally minimal or none; Medicare protections prohibit plans from charging members for standard grievances or appeals processing. If you experience an urgent access-to-care issue, ask explicitly for an expedited or “72-hour” review and request immediate transfer to a nursing or clinical reviewer. If the plan fails to meet federal timelines, document the breach and escalate to Medicare or your state regulator to preserve any statutory remedies.

Practical tips to get faster, better outcomes

Be concise and evidence-focused: cite the CPT/HCPCS codes, drug NDC, provider credentials, and clinical notes that support medical necessity. Use secure messaging to add attachments and to create a written trail. When speaking on the phone, record the call reference number and the name and employee ID of the agent; ask for an estimated resolution date and a direct line or email for follow-up. If language assistance or disability accommodations are needed, request a qualified interpreter and auxiliary aids — plans are required by law to provide these at no cost.

Finally, keep an annual folder (digital or paper) of all member communications, EOBs, and prior authorizations. When you change providers, give new clinicians copies of prior authorizations and denial letters; many delays result from missing or inconsistent documentation. If you need help interpreting plan language — copays, coinsurance, out-of-pocket maximums — bring a recent Summary of Benefits (SOB) to any customer service or SHIP consultation so you’re all referring to the same document.

How do I speak to Medicaid customer service?

★ Department of Health Care Services

1. California State Contacts.
2. Eligibility.
3. Enrollment.
4. ☎ Call the Medi-Cal Helpline: 800-541-5555, or 916-636-1980.

What is the timely filing limit for Elderplan claims?

Replacement claims must be submitted within timely filing limits (180 days from DOS or as contractually agreed upon). Failure to meet the deadline will result in an untimely filing denial as well as a recoupment of the original payment.

How to check Elderplan OTC card balance?

Access the OTC+Flex Member Portal at mybenefitscenter.com to manage your OTC and Flex benefits in one simple place. You’ll be able to: Check your OTC balance. Check your Flex balance.

What is the best Medicare Advantage program for seniors?

An AI Overview is not available for this searchCan’t generate an AI overview right now. Try again later.AI Overview There is no single “best” Medicare Advantage plan, as the best choice depends on your individual health needs and location, but top-rated providers like AARP/UnitedHealthcare, Cigna, Kaiser Permanente, and Humana are often recommended for their wide availability, low costs, and strong member satisfaction ratings. When choosing a plan, consider your preferred doctors, prescription drug needs, budget, and desired extra benefits like dental or vision coverage, and always verify your plan’s provider network and costs in your specific area.  Top Providers and Their Strengths

• AARP/UnitedHealthcare: . Opens in new tabConsidered best overall by some sources, known for a strong combination of low costs, broad nationwide availability, and good coverage. 
• Cigna: . Opens in new tabA top-rated choice for its low costs and excellent member experience. 
• Kaiser Permanente: . Opens in new tabHighly rated for member satisfaction and often recommended for strong drug coverage and patient experience, though availability is more limited than national plans. 
• Humana: . Opens in new tabA leading provider with excellent member satisfaction, nationwide availability, and strong Part D prescription drug offerings. 
• Aetna: . Opens in new tabA good option for its wide availability and, for some, its good value plans. 

Factors to Consider When Choosing a Plan

• Your Doctors: Ensure your preferred doctors and specialists are in the plan’s network, which is a crucial first step, notes ValuePenguin. 
• Costs: Compare monthly premiums, deductibles, copayments, and out-of-pocket maximums to find a plan that fits your budget. 
• Prescription Drugs: Check if the plan includes Medicare Part D prescription drug coverage and if your specific medications are on the plan’s formulary. 
• Extra Benefits: Decide if you need additional coverage for dental, vision, hearing, or other health and wellness perks that Medicare Advantage plans may offer. 
• Member Satisfaction and Ratings: Look at the Medicare star ratings and member satisfaction scores for different plans and carriers, which can indicate the quality of service and care. 
• Plan Type: Understand the difference between an HMO (which requires you to use in-network providers, except for emergencies) and a PPO (which offers more flexibility but may cost more to see out-of-network doctors). 

How to Research and Enroll

• Use Medicare.gov: This official government website provides a tool to compare plans in your specific area. 
• Check Your Local Plan Offerings: Availability and benefits vary significantly by county and state, so always check what is offered in your location. 

AI responses may include mistakes. Learn moreWhat is the Best Medicare Advantage Plan in 2025? – ValuePenguinAug 6, 2025 — AARP/UHC: Best overall. Popular and has good ratings. Low-cost plans with many extras. Blue Cross: Best doctor network.ValuePenguinBest Medicare Advantage Plans of 2025 – SeniorLiving.orgApr 2, 2025 — We spent over 75 hours researching and reviewing more than a dozen insurance carriers before choosing Humana as our top…SeniorLiving.org(function(){
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Is Elderplan a Medicare Advantage plan?

At Elderplan, we understand that your health needs are unique, and your well-being is our priority. Our Medicare Advantage Plans have been created to provide comprehensive coverage and exceptional care for our members.

What is the Elderplan OTC Flex spending benefit?

Use your Flex card for out-of-pocket dental, hearing, vision, and fitness expenses. Your benefit is $500 annually. These dollars are in addition to the benefits you already receive from Elderplan. You can use your Flex card at any provider that accepts Visa.