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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.”
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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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