Appeals

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

• You must file this type of appeal in writing.
• You must contact Health Alliance Plan within 60 calendar days of receiving written notification of the denial.
• For appeals involving payment of medical benefits, we’ll respond within 60 calendar days after we receive your request.
• For appeals involving prescription drug benefits, we’ll respond within 7 calendar days after we receive your request.

Where to file an appeal

By fax

(313) 664-5866

In writing

Health Alliance Plan
Attn: Appeal and Grievance Department
1414 E Maple Rd
Troy, MI 48083

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

• You may request either a standard or expedited 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 must request a standard appeal in writing.
• You may request an expedited appeal orally or in writing.
• You must contact Health Alliance Plan within 60 days of receiving written notification of the denial.
• For standard appeals involving medical care, we’ll respond within 30 calendar days* after we receive your request.
• For expedited appeals involving medical care, we’ll respond within 72 hours* after we receive your request.

Where to file an appeal

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

Phone (expedited appeals only)

HMO and HMO-POS plans

• HAP Medicare Connect (HMO): (800) 801-1770 (TTY: 711)
• HAP Senior Plus Henry Ford Tiered Access (HMO): (800) 801-1770 (TTY: 711)
• HAP Medicare MedicalAccess (HMO): (800) 801-1770 (TTY: 711)
• HAP Medicare Superior (HMO): (800) 801-1770 (TTY: 711)
• Henry Ford Select (HMO): (800) 801-1770 (TTY: 711)
• HAP Senior Plus (HMO-POS): (800) 801-1770 (TTY: 711)

PPO plans

• HAP Senior Plus (PPO): (888) 658-2536 (TTY: 711)
• HAP Medicare Explore (PPO): (888) 658-2536 (TTY: 711)
• HAP Medicare Prime (PPO): (888) 658-2536 (TTY: 711)
• HAP Member Assist (PPO): (888) 658-2536 (TTY: 711)

D-SNP and C-SNP plans

• HAP Medicare Complete Duals (HMO D-SNP): (800) 848-4844 (TTY: 711)
• HAP Medicare Complete Assist (PPO D-SNP): (800) 848-4844 (TTY: 711)
• HAP Medicare Diabetes and Heart (PPO C-SNP): (800) 848-4844 (TTY: 711)

Customer service representatives can take your call during the following times:

• Oct. 1 - March 31 from 8 a.m. to 8 p.m., seven days a week
• April 1 - Sept. 30 from 8 a.m. to 8 p.m., Monday through Friday

At all other times, you may access our interactive voice recording system at the same number. Leave your name and phone number, and a customer service representative will return your call the next business day. Please don’t share personal health information when you leave your message.

Fax

(313) 664-5866

Mail

Health Alliance Plan
Attn: Appeal and Grievance Department
1414 E Maple Rd
Troy, MI 48083

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

Request for Redetermination of Medicare Prescription Drug Denial

• You must contact Health Alliance Plan within 60 calendar days of receiving written notification of the denial.
• For standard appeals involving prescription drug benefits, we’ll give you a decision within 7 calendar days.
• For expedited appeals involving prescription drug benefits, we’ll give you a decision within 72 hours.

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.

Send the completed form to:

Health Alliance Plan
Attn: Customer Service Department
1414 E Maple Rd
Troy, MI 48083

Learn more about appointing a representative