Appeals

Our process for accepting and responding to appeals

If we deny your request for a coverage decision or payment, you have the right to request an appeal.

How you make your appeal, and how long we have to respond, depends on many factors. This includes whether the appeal involves care you’ve already received or future care. It also depends on whether the appeal involves medical benefits or prescription drug benefits.

If you’re appealing a decision about care you’ve already received:

  • You must file this type of appeal in writing.
  • You must contact HAP within 60 calendar days of receiving written notification of the denial.
  • For appeals involving payment of medical benefits, we’ll respond within 60 calendar days after we receive your request.
  • For appeals involving prescription drug benefits, we’ll respond within 7 calendar days after we receive your request.

Where to file an appeal

By fax

(313) 664-5866

In writing

Health Alliance Plan
ATTN: Appeal and Grievance Department
1414 E Maple Rd
Troy, MI 48083

If you’re appealing a decision about care you haven’t yet received:

  • You may request either a standard or expedited appeal. An expedited appeal is for urgent situations in which waiting for a standard appeal could seriously harm your health or your ability to function.
  • You must request a standard appeal in writing.
  • You may request an expedited appeal orally or in writing.
  • You must contact HAP within 60 days of receiving written notification of the denial.
  • For standard appeals involving medical care, we’ll respond within 30* calendar days after we receive your request.
  • For expedited appeals involving medical care, we’ll respond within 72* hours after we receive your request.

Where to file an appeal

You may file your appeal with our Customer Service department by one of the following methods:

Phone (expedited appeals only)

HMO plans

PPO plans

HMO-POS plan

D-SNP and C-SNP plans

Customer service representatives can take your call during the following times:

  • Oct. 1 - March 31 from 8 a.m. to 8 p.m., seven days a week
  • April 1 - Sept. 30 from 8 a.m. to 8 p.m., Monday through Friday

At all other times, you may access our interactive voice recording system at the same number. Leave your name and phone number, and a HAP customer service representative will return your call the next business day. Please don’t share personal health information when you leave your message.

Fax

(313) 664-5866

Mail

Health Alliance Plan
ATTN: Appeal and Grievance Department
1414 E Maple Rd
Troy, MI 48083

Use the following form to file an appeal concerning the denial of a medication or payment for a medication:

Request for Redetermination of Medicare Prescription Drug Denial (PDF)

  • You must contact HAP within 60 calendar days of receiving written notification of the denial.
  • For standard appeals involving prescription drug benefits, we’ll give you a decision within 7 calendar days.
  • For expedited appeals involving prescription drug benefits, we’ll give you a decision within 72 hours.

You or your doctor can start an appeal. You also have the right to appoint someone to act on your behalf and request a coverage determination, as well as file a grievance or appeal. The person you name is your appointed representative. If you want someone to act for you, you and that person must sign and date the Appointment of Representative form (PDF).

Send the completed form to:

Health Alliance Plan
ATTN: Medicare Advantage Grievances
1414 E Maple Rd
Troy, MI 48083

Learn more about appointing a representative

What to do if you have a problem

If you have a complaint or a problem, contact us right away. We may be able to resolve your complaint or approve a request over the phone.

You also may refer to the chapter on If you have a problem or complaint (coverage decisions, appeals, complaints) in your Evidence of Coverage.

If you prefer to contact Medicare directly, you can call 1-800-Medicare or (800) 633-4227 24 hours a day, seven days a week. TTY users should call (877) 486-2048. Or you can file a complaint on the Medicare website.

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*The time to complete standard service and expedited requests may be extended by up to 14 calendar days if we need more information and the extension is in your best interest. If we take an extension, we’ll notify you in writing of the reason we need more time. You may file an expedited grievance if you disagree with our decision to take an extension. You also may request a 14-day extension if you need more time to provide us with additional information.

Health Alliance Plan (HAP) has HMO, HMO C-SNP, HMO-POS, and PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP), HAP Medicare Complete Assist (PPO D-SNP), and HAP CareSourceTM MI Coordinated Health (HMO D-SNP) are Medicare health plans with a Medicare contract and a contract with the Michigan Medicaid Program that provides benefits of both programs to enrollees. Enrollment depends on contract renewals.