Page 42 - PPO_Member_Kit

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People who were involved in the Initial Adverse Benefit Determination will not be
included in making the decision for the Appeal. People who were involved in a level
one Appeal for a Group Member will not be included in making a decision for a level two
Appeal.
If a Member is still not satisfied with the final decision after the Internal Appeal Process
or Alliance has gone past the allowed review period, the Member can ask for an
External Independent Review that is allowed under the Patient’s Right to Independent
Review Act. Members can request an External Review by contacting the Director of the
Department of Insurance and Financial Services within
sixty (60) days
of exhausting
the Alliance Internal Appeal Process at:
Department of Insurance and Financial Services
Healthcare Appeals Section
Office of General Counsel
611 Ottawa, Third Floor
P.O. Box 30220
Lansing, MI 48909-7720
Members can also call the Director toll-free at (877) 999-6442.
Alliance will automatically provide Members with the
FIS 0018 (8/12) - Health Care
Request for External Review form after the final appeal decision.
This form is
necessary to ask for an external review. You can also get a copy of the form anytime by
going to the Department of Insurance and Financial Services website listed below. You
can also call at the number listed below and ask for the form.
Other Rights
:
If you are a Member of a Group Health Plan subject to ERISA, you may bring a lawsuit
under section 502(a) of ERISA if you have exhausted the Alliance Internal Appeal
Process. Ask your employer if you are part of an ERISA group.
For more information
:
Members can call Alliance’s Client Services at (888) 999-4347.
If you are deaf, hard of hearing or speech impaired, please use our toll-free
TTY/TDD line at (800) 649-3777.
Call the Department of Insurance and Financial Services directly at the number
listed above or visit their website at
For assistance you may contact the Michigan Health Insurance Consumer
Assistance Program, 611 W. Ottawa Street, Lansing, MI 48933 at 877-999-6442 or
email
AHL-GRV 9/2013
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