Page 47 - EPO_Member_Kit

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Alliance’s Two-Level Decision-Making Process Is As Follows:
LEVEL I: Vice President, Client Services
LEVEL II: Alliance Grievance Committee
If the enrollee or their representative is dissatisfied with the response received at the first level of
the process, they may continue to progress through the grievance process by submitting, in
writing a grievance request for the second level. The request must be submitted within sixty (60)
days from the date of the letter advising of the first-level review. [Example, first-level decision
letter dated March 1; second-level request must be received by May 1.]
During the second and final Alliance internal level, the enrollee or their representative (with the
appropriate authorization) has the option of presenting his/her grievance in person to the Alliance
Grievance Committee.
After the enrollee exhausts all internal levels of the Grievance Process (or if Alliance exceeds their
allowable review period for the grievance) and remains dissatisfied with Alliance’s final
determination, he/she may further pursue an external independent review under the Patient’s
Right to Independent Review Act, by contacting the Michigan Insurance Commissioner at the
Office of Financial and Insurance Regulation, Division of Insurance, Health Plans Division,
611 West Ottawa, Third Floor, P.O. Box 30220, Lansing, MI 48909-7720, phone: (877) 999-6442,
within sixty (60) days of the notice of the exhaustion of Alliance’s internal grievance process.
Alliance will automatically provide enrollees with the necessary form (FIS 0018 - Health Care
Request for External Review) to request an external review. For additional information, enrollees
may contact Alliance’s Client Services department at
(313) 664-7010
or
(888) 999-4347
toll-free, or
the Division of Insurance directly at the above number, or by visiting the Web site of the State
Insurance Division at michigan.gov/ofis.