How to file a grievance and appeal
We follow all federal civil rights laws. We don’t discriminate based on:
- race
- color
- national origin
- age
- disability
- sex
A grievance may be a complaint or a dispute about your unhappiness with the quality, availability or delivery of your care. We’ll keep your grievance private.
If you’re unhappy, you can file a grievance. If you feel discriminated against, you can file a grievance.
Grievance cases are:
- Quality of health care services, like safety issues
- Access and availability of care
- Attitude and service of providers, office staff or HAP Empowered staff
- The benefits in your plan
By phone:
(888) 654-2200 (TTY: 711)
We have an appeal and grievance expert to help. They can help you write a grievance. This can be done by phone, in writing or in person. We also have translator services.
In person:
HAP Empowered
2850 W. Grand Blvd.
Detroit, MI 48202
HAP Empowered
2050 S. Linden Rd.
Flint, MI 48532
By mail:
HAP Empowered
P.O. Box 2578
Detroit, MI 48202
- Your doctor or an approved person may file a grievance for you
- We’ll send you a letter within five days that acknowledges receipt of the grievance.
- We’ll fully investigate your grievance.
- We’ll send you an answer in writing no later than 90 days from the date we received your grievance.
- We may extend the time frame by up to 14 days if you ask an extension. Or, if we need more information and think the delay is in your best interest. If we extend the time, we’ll call and let you know. We’ll also mail you a letter reminding you we’re extending our time. If you’re not happy we need more time, you can call or write to us and let us know.
- If you’re not happy we need more time, you can call or write to us and let us know and we’ll answer you in 72 hours.
Appeals
Pre-service/post-service appeals
- You can file an appeal if we deny, suspend, end or reduce a covered health care service. Samples are
- Not approving or paying for a service or item your doctor asks for
- Stopping a service approved in the past
- If we decide to reduce or stop a service, you can keep getting the service until we make a final ruling. You can also keep getting the service while you’re waiting for a ruling from the State Fair Hearing.
- You have 60 calendar days from the date you get the denial to file an appeal.
- You can do this in person, in writing, or by phone. The appeal coordinator can help you.
- You can choose someone to represent you. You can bring info you feel will help us make a better ruling.
- Once we get your appeal request, we’ll review your request and mail you a ruling within 30 days. We can extend this time by an extra 14 days if you ask us to. Or, if we think giving extra time is in your best interest.
- You can ask a state fair hearing if we deny your pre-service or post-service appeal. It must be within 120 days of the denial of HAP’s final ruling.
Call HAP Empowered at (888) 654-2200 (TTY: 711). Or, call the state of Michigan at (800) 642-3195 to have a hearing request form (DCH-0092) sent to you. Fill out the form and return it to the address on the form.
If you’re unhappy with our finding or we don’t give a ruling within 30 days, you can ask for an outside review from the Department of Insurance and Financial Services. Your request must be in writing and sent to:
Department of Insurance and Financial Services
Office of General Counsel – Appeals Section
P.O. Box 30220
Lansing, MI 48909-7720
Expedited pre-service appeal
If you or a doctor say the 30-calendar-day time frame could harm your health, your pre-service appeal will be an expedited request. These appeals are handled in 72 hours.
Outside Medical review by the Department of Insurance and Financial Services (DIFS)
You can ask for an outside review if you don’t get an answer within 30 calendar days. You can also do this if you’re not happy with HAP Empowered’s ruling. Write to:
Department of Insurance and Financial Services
Office of General Counsel – Appeals Section
P.O. Box 30220
Lansing, MI 48909-7720
You must appeal in writing to the DIFS within 120 calendar days of the ruling. You must complete HAP Empowered Medicaid's appeal process before asking for review from the DIFS. The appeal coordinator will explain the outside review process. We can also mail the outside review forms to you.
DIFS will send your appeal to an independent review organization for consideration, as needed. A ruling will be mailed to you within 14 calendar days of accepting your appeal.
Are you not happy with our final ruling? Do you want your appeal request to be expedited? You have 10 calendar days to file an appeal to DIFS.
- If we're going to reduce or stop a service already approved, you can keep getting benefits during the appeal and state fair hearing process. The appeal must be filed within 10 days of the date the denial letter was mailed
- You must ask to keep the service
The service will stop if:
- You withdraw your appeal
- You don’t ask for a state fair hearing within 10 days of getting the denial letter
- A state fair hearing ruling is made against you
- The authorization ends or service limits are met
