If we deny your request for coverage, payment or an exception, you have the right to request an appeal.
Grievances, Appeals and Determinations
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:
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.
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.
Prescriptions
Download the Request for Medicare Prescription Drug Coverage Determination form (PDF) for prescription drug needs.
Medical Services
For information on how to request an organization determination for medical services, please click here.
You have the right to make a complaint when you experience problems with quality of care, customer service, long wait times and other issues not related to your plan coverage.
Contact us
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.
You can also contact us to obtain an aggregate number of grievances, appeals and exceptions filed with HAP. The time to complete standard service and expedited requests may be extended by up to 14 calendar 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.
You also may refer to the chapter on If you have a problem or complaint (coverage decisions, appeals, complaints) in your Evidence of Coverage.
This information is not a complete description of benefits. For more information, call HAP customer service at (800) 868-9885 (TTY: 711) Oct. 1 - March 31 from 8 a.m. to 8 p.m., seven days a week or April 1 - Sept. 30 from 8 a.m. to 8 p.m., Monday through Friday.
If you prefer to contact Medicare directly, you can call 1-800-Medicare or (800) 633-4227 24 hours a day, seven days a week. TTY users should call (877) 486-2048. Or you can file a complaint on the Medicare website.
Manage your Medicare benefits and view personalized plan information
Health Alliance Plan (HAP) has HMO, HMO C-SNP, HMO-POS, and PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP), HAP Medicare Complete Assist (PPO D-SNP), and HAP CareSourceTM MI Coordinated Health (HMO D-SNP) are Medicare health plans with a Medicare contract and a contract with the Michigan Medicaid Program that provides benefits of both programs to enrollees. Enrollment depends on contract renewals.