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Grievances

Tell us what’s not working so we can fix it

You have the right to make a complaint about concerns or problems related to your coverage or care.

A grievance is a type of complaint you can make about us or one of our network providers or pharmacies. For example, you could file a complaint if you have a problem with the quality of your care, waiting times for appointments, or the cleanliness or condition of your doctor's office.

For complaints about a denial of a request for coverage of health care services, prescription drugs or payment for services or drugs you’ve already received, you need to file an appeal.

If you file a standard grievance, we will respond within 30 calendar days after receiving your complaint.

If you file a grievance because you are unhappy that we did not review a coverage decision or appeal for you under expedited timeframes, we will respond to that complaint within 24 hours. We call that type of complaint an “expedited grievance”.

Also, if we ever take extra days to investigate an appeal or grievance for you (which is called taking an “extension”), you can file a complaint about that and we will also respond to your concern within 24 hours.

Please contact Customer Service for information about filing an “expedited grievance.”

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You also may refer to Chapter 7 or Chapter 9 in your Evidence of Coverage, titled: What to do if you have a problem or complaint (coverage decisions, appeals, complaints). If you prefer to contact Medicare, you can call (800) Medicare (800-633-4227) or TTY/TDD (877) 486-2048 24 hours a day, seven days a week. Or you can file a complaint at the Medicare website.

Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment depends on contract renewals.