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You have the right to make a complaint about concerns or problems related to your coverage or care.
A grievance is a type of complaint you can make about us or one of our network providers or pharmacies. For example, you could file a complaint if you have a problem with the quality of your care, waiting times for appointments, or the cleanliness or condition of your doctor's office.
For complaints about a denial of a request for coverage of health care services, prescription drugs or payment for services or drugs you’ve already received, you need to file an appeal.
If you file a grievance, we’ll respond within 30 calendar days after receiving your complaint. If you file a grievance because we denied an “expedited coverage decision,” an “expedited appeal” or if we took an extension on your appeal, we’ll automatically give you an “expedited grievance.”
If you have an “expedited grievance,” we’ll respond within 24 hours. Please contact Customer Service for information about filing an “expedited grievance.”
Grievances must be filed within 60 days of the event that gives rise to the grievance. You may file a grievance either orally or in writing, by one of the following methods:
Call the customer service department for your plan:
Our team members can take your call during the following times:
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 do not share personal health information when you leave your 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.
If you’re concerned about the quality of care you received, including care during a hospital stay, you also can file a complaint with an independent organization called KEPRO.
Write to or call KEPRO:
5201 West Kennedy Blvd., Suite 900
Tampa, FL, 33609
You have the right to have another person file a grievance on your behalf. The person you name would be 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) and then mail the completed form to our Customer Service team at this address:Health Alliance Plan
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Learn more about appointing a representative.
Send us an email or give us a call right away. Contact us. We may be able to resolve your complaint over the phone.
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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 at the Medicare website. The Office of the Medicare Ombudsman (OMO) can help you.Copyright © 2018 HAP
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).
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