2010 Medicare Solutions

What is an Appeal?
An Appeal is the type of complaint you make when you want us to reconsider and change a decision we have made about what services or benefits are covered for you or what we will pay for a service or benefit. For example, if we refuse to cover or pay for services you think we should cover, you can file an appeal. For complaints that are not related to coverage decisions, you need to file a Grievance.

The Appeal Process
You must request an appeal within 60 calendar days after our initial coverage decision. We can give you more time if you have a good reason for missing this deadline. How you make your appeal, and how long we have to respond, depends on whether you are appealing a decision about future care or care you have already received, and whether you are appealing a decision about medical benefits or prescription drug benefits.

Where to file your appeal:
You must file your appeal with our Client Services Department, by one of the following methods:

By Phone:

Phone HAP Senior Plus Client Services
(313) 664-7015 or
(800) 801-1770 toll-free
TDD: (800) 956-4325 toll-free

Phone Alliance Medicare PPO Client Services
(313) 664-9050
(888) 658-2536 toll-free
TDD: (800) 956-4325 toll-free

Phone Alliance Medicare Rx Client Services
(313) 664-9064
(800) 765-3436 toll-free
TDD: (800) 956-4325 toll-free

Office Hours:
Monday - Friday 8 a.m. to 8 p.m.
Saturday 8 a.m. to noon.
At all other times, you may access our Interactive Voice Recording system at the same number.

Extended hours from November 15 - March 1:
7 days a week, including holidays, 8 a.m. to 8 p.m.

By Fax: (313) 664-5866

In Writing:

Mail Health Alliance Plan
ATTN: Medicare Advantage Grievances
2850 West Grand Boulevard
Detroit, MI 48202

How to file your appeal and how long we have to respond:

Appealing a decision about payment for care you have already received:

You must file this type of appeal in writing.
For appeals involving medical benefits, we have up to 60 days to respond after we receive your request.
For appeals involving prescription drug benefits, we have up to seven (7) calendar days to respond after we receive your request.

Appealing a decision about future care (care you have not already received):

You may request either an expedited or a standard appeal. An expedited appeal is for urgent situations where waiting for a standard decision could seriously harm your health or your ability to function.
You may request an expedited appeal orally or in writing.
You must request a standard appeal in writing.
For expedited appeals involving medical care, we have up to 72 hours to respond after we receive your request.
For standard appeals involving medical care, we have up to 30 calendar days to respond after we receive your request.
For expedited appeals involving prescription drug benefits, we have up to 72 hours to give you a decision.
For standard appeals involving prescription drug benefits, we have up to seven (7) calendar days to give you a decision.

Appointing someone to act on your behalf
You may have another person, such as your doctor, lawyer or family member, request an appeal on your behalf. The person you name would be your appointed representative. If you want someone to act for you, then you and that person must sign and date the Appointment of Representative form (requires Adobe Reader), which gives the person legal permission to act as your representative. Mail the completed form to the Client Services address above.