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.
    • You must contact HAP within 60 days of receiving written notification of the denial.
    • 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.
    • You must contact HAP within 60 days of receiving written notification of the denial.
    • For standard appeals involving medical care, we’ll respond within 301 calendar days after we receive your request.
    • For expedited appeals involving medical care, we’ll respond within 721 hours after we receive your request.

    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)

    • For standard appeals involving prescription drug benefits, we’ll give you a decision within seven calendar days.
    • For expedited appeals involving prescription drug benefits, we’ll give you a decision within 72 hours.
    • You must contact HAP within 60 days of receiving written notification of the denial.
  • 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)

    Call the customer service department for your plan:

    Our team members can take your call during the following times:

    • 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

    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

    Through the Message Center

    1. Log in to your hap.org account.
    2. Click on Message Center at the top of the page.
    3. Click on Compose Message to send us a new message.

    If you need to register for your online HAP account, have your ID card ready and go to hap.org/login. Click on Register now.

  • Appointing a representative

    You or your doctor can start an appeal. You also 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 over the phone.

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2018 Health Alliance Plan of Michigan
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CMS Accepted 11/21/18

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 Medicare Michigan customer service at (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).

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

  • 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)