Appeals

Our process for accepting and responding to appeals

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

How you make your appeal, and how long we have to respond, depends on many factors. This includes whether the appeal involves care you’ve already received or future care. It also depends on whether the appeal involves medical benefits or prescription drug benefits.

  • File an appeal for care you’ve already received

    If you’re appealing a decision about care you’ve already received:

    • You must file this type of appeal in writing.
    • For appeals involving payment of medical benefits, we’ll respond within 60 days after we receive your request.
    • For appeals involving prescription drug benefits, we’ll respond within seven calendar days after we receive your request.
  • File an appeal for care you haven’t received yet (future care)

    If you’re appealing a decision about care you haven’t yet received:

    • You may request either an expedited or a standard appeal. An expedited appeal is for urgent situations in which waiting for a standard appeal could seriously harm your health or your ability to function.
    • You may request an expedited appeal orally or in writing.
    • You must request a standard appeal in writing.
    • For expedited appeals involving medical care, we’ll respond within 721 hours after we receive your request.
    • For standard appeals involving medical care, we’ll respond within 301 calendar days after we receive your request.
    • For expedited appeals involving prescription drug benefits, we’ll give you a decision within 72 hours.
    • For standard appeals involving prescription drug benefits, we’ll give you a decision within seven calendar days.

    1The 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’ll 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 also may request a 14-day extension if you need more time to provide us with additional information.

    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 (633-4227) or TTY/TDD {877) 486-2048 24 hours a day, seven days a week. Or you can file a complaint at the Medicare website. The Office of the Medicare Ombudsman (OMO) can help you.

  • File an appeal for denial of a medication or payment for a medication

    You may use the following form to file an appeal concerning denial of a medication or payment for a medication:

    Request for Redetermination of Part D Drug Denial (PDF)

  • Where to file your appeal

    You must file your appeal with our Customer Service department by one of the following methods:

    By phone (expedited appeals only)

    HAP Senior Plus®
    (313) 664-7015 or (800) 801-1770
    TTY: 711

    HAP Senior Plus® (PPO)
    (313) 664-9050 or (888) 658-2536
    TTY: 711

    Customer service office hours

    • Feb. 15 to March 31: 8 a.m. to 8 p.m. Monday through Friday; 8 a.m. to noon Saturday.
    • April 1 to Sept. 30: 8 a.m. to 8 p.m. Monday through Friday.
    • Oct. 1 to Feb. 14: 8 a.m. to 8 p.m. seven days a week.

    At all other times, you may access our Interactive Voice Recording system at the same number and leave your name and phone number. A HAP Medicare Customer Service Representative will return your phone call the next business day. Please don’t share personal health information when you leave your message.

    By fax

    (313) 664-5866

    In writing

    Health Alliance Plan
    ATTN: Appeal and Grievance Department
    2850 W. Grand Blvd.
    Detroit, MI 48202

    By email

    msweb1@hap.org

  • Appointing a representative

    You have the right to appoint someone to act on your behalf and request a coverage determination, as well as file a grievance or appeal. The person you name is your appointed representative. If you want someone to act for you, you and that person must sign and date the Appointment of Representative form (PDF).

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

    Send the form to us at this address:

    Health Alliance Plan
    ATTN: Medicare Advantage Grievances
    2850 W. Grand Blvd.
    Detroit, MI 48202

    Learn more about appointing a representative.

  • Provider – Waiver of Liability

    To file an appeal, a noncontracted doctor or other noncontracted provider who has furnished a service to the enrollee must complete and submit the Waiver of Liability form with their appeal request. This form is required by Medicare and must be received before we can begin to process the appeal. Download the Waiver of Liability Statement (PDF).

What to do if you have a problem

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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Copyright © 2017 HAP
2017 Health Alliance Plan of Michigan
Y0076_ALL_2018029 Website MP
CMS Approved: 6/26/2017
Last Update: 6/21/2017

HAP Senior Plus HMO, HMO-POS, and PPO are health plans with a Medicare contract. Enrollment in these plans depends on contract renewal. HAP Senior Plus PPO is a product of Alliance Health and Life Insurance Company, a wholly owned subsidiary of HAP. Alliance Medicare Supplement 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. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

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  • HAP Medicare Sales:

    (877) 547-5186 (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