Grievances, appeals and determinations

Contact us for information on how to obtain an aggregate number of grievances, appeals and exceptions filed with HAP.

What’s important to you is important to us. If you’re ever dissatisfied with any aspect of your plan, please contact us so we can resolve your concerns quickly.

Ways to resolve concerns

You have several options to address and resolve any concerns you have with your health plan, including:

  • Appeals

    If we deny your request for coverage, payment or an exception, you have the right to request an appeal.

    Learn more.

  • Exceptions

    You or your doctor can request a Formulary Exception if a drug your doctor prescribes is not on our drug list, or if the drug is subject to one of our utilization management requirements, such as step therapy or quantity limits.

    A drug that is not on our drug list that we approve through the Formulary Exception Process will be considered a nonpreferred generic (Tier 2) or nonpreferred brand (Tier 4) drug.

    Learn more.

  • Determinations

    When we make an initial decision about a prescription drug or medical service, we’ll explain whether we’ll provide the drug or service you are requesting or pay for the one you are already received.

    Determination Request for Medicare Prescription Drug Coverage (PDF)

    You must have Adobe Reader to download PDF files. Download Adobe Reader for free.

    Learn more.

  • Grievances

    You have the right to make a complaint if you have concerns or problems related to your care or coverage, including but not limited to waiting times when you fill a prescription, the way your plan pharmacist or others behave, or the cleanliness of a plan pharmacy.

    Learn more.

Your first step

If you have a complaint or a problem, contact us. We may be able to resolve your complaint or approve a request over the phone.

Medicare explained in minutes

Learn what Medicare is, how it works, and the coverage options available to you with these short, informative videos.

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  • Annual Enrollment Period Seminar

    Get answers to your Medicare questions! Learn how Medicare works and learn about HAP's wide range of Medicare solutions.

  • Annual Enrollment Period Seminar

    Get answers to your Medicare questions! Learn how Medicare works and learn about HAP's wide range of Medicare solutions.

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You also may refer to Chapter 7 or Chapter 9 in your Evidence of Coverage, titled: What to do if you have a problem or complaint (coverage decisions, appeals, complaints).

If you prefer to contact Medicare, you can call (800) Medicare (800-633-4227) or TTY/TDD (877) 486-2048 24 hours a day, seven days a week. Or you can file a complaint on the Medicare website. The Office of the Medicare Ombudsman (OMO) can help you.

To obtain an aggregate number of grievances, appeals and exceptions filed with the plan, contact us.

The time to complete standard service and fast requests may be extended by up to 14 days if we need more information and the extension is in your best interest. if we take an extension, we will notify you in writing of the reason we need more time. You may file an expedited grievance if you disagree with our decision to take an extension. You may also request a 14 day extension if you need more time to provide us with additional information.

If you have a complaint or a problem, contact us right away. We may be able to resolve your complaint or approve a request over the phone.

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2018 Health Alliance Plan of Michigan
Y0076_2019 HAP Website
CMS Accepted 10/1/2018

HAP Senior Plus (HMO)/(HMO-POS)/(PPO) and HAP Primary Choice Medicare (HMO) are health plans with Medicare contracts. HAP Empowered Duals (HMO SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment in the plans depends on contract renewals. HAP Senior Plus (PPO) is a product of Alliance Health and Life Insurance company, a wholly owned subsidiary of HAP.

This information is not a complete description of benefits. For more information call (800) 868-9885 (TTY: 711) 8 a.m. to 8 p.m., seven days a week (Oct. 1 – March 31) / 8 a.m. to 8 p.m., Monday through Friday (April 1 - Sept. 30).

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  • HAP Medicare Sales:

    (800) 868-9885 (TTY: 711)

  • (800) 868-3153 (TTY: 711)

    HAP Senior Plus®

    (800) 801-1770 (TTY: 711)

  • HAP Senior Plus®(PPO)

    (888) 658-2536 (TTY: 711)

  • Alliance Medicare Supplement:

    (800) 873-7526 (TTY: 711)