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HAP-GRV 9/2013
1
HEALTH ALLIANCE PLAN
COMMERCIAL GROUP AND INDIVIDUAL APPEAL POLICY
PURPOSE
To provide any Health Alliance Plan (HAP) Member or the Member’s Authorized
representative a way to find a solution to a situation where the Member is not satisfied
or feels wronged by the services, benefits and/or policies and procedures of HAP or its
providers or receives an Adverse Benefit Determination (collectively “Appeal Process”).
This policy applies to both pre-service and post service Appeals.
SUMMARY
The Grievance Policy allows members to file an Appeal when you receive a denial for
payment or services. Individual Plan Members have a one level decision-making Appeal
Process. Group Plan Members have a two level decision-making process.
The Member, their Authorized Representative or their practitioner may start the Appeal
Process by sending a request in writing to:
HAP
Attention: Manager of Grievance Department
2850 West Grand Boulevard
Detroit, MI 48202
Members may also submit Appeals by fax to 313-664-5866 or in person at the HAP
location at 2850 West Grand Boulevard or at this other HAP location: 21700
Northwestern Highway, Southfield, MI 48034.
Members may receive this policy in an alternative language (Arabic, Farsi, Spanish or
another language) by contacting our Client Services Department at the number listed
within this policy.
Members may submit an Appeal in writing within 180 days from the date of the initial
denial. Group Plan Members may submit a request for 2
nd
level Appeal within 60 days
from the date of the 1
st
level Appeal decision.
Members should include any extra information such as:
Medical evaluation report
Medical records
Other important facts to support the request.