Grievances and Appeals
HOW TO FILE A GRIEVANCE
A grievance is defined as a complaint (oral or written expression of dissatisfaction) submitted by or on behalf of a member. HAP Midwest Health Plan accepts grievances from any individual the member authorizes in writing to represent them including, but not limited to, a physician. Grievances include concerns related to:
  • Quality of health care services, including safety issues
  • Access and availability of care, including a grievance regarding an adverse determination made pursuant to utilization review
  • Attitude and service of practitioners, providers and office staff, ancillary services, etc
  • Benefits or claims payment, handling or reimbursement for health care services
  • Matters pertaining to the contractual relationship between HAP Midwest Health Plan and a member.
All members receive written information at the time of their enrollment with HAP Midwest Health Plan which outlines the process available to assist them with filing a grievance or an appeal. A member may file (or have filed on his/her behalf) a grievance verbally by calling the toll free number of (888) 654-2200. A member may also file a written grievance by documenting the issue and faxing it to (248) 663-3771, visiting on site or mailing it directly to the Customer Services Department at the corporate office at:
  • HAP Midwest Health Plan
  • Attention: Customer Service Department
  • PO Box 2578
  • Detroit, MI 48202
Our customer Services representatives are available to give enrollees assistance in completing forms and taking other procedural steps. HAP Midwest Health Plan provides interpreter services and TTY/TDD toll-free numbers. HAP Midwest Health Plan acknowledges receipt of each grievance in writing.

Filing Timeframes and Methods: All initial grievances/appeals must be filed up to 90 days of the member’s date of discovery of the problem, complaint or aggrieved situation. All appeals must be filed not more than 90 days after the date of HAP Midwest Health Plan's adverse determination. Grievances and appeals may be filed in writing, by telephone, or in person at our corporate office. HAP Midwest Health Plan assists members to document their grievance or appeal request as needed. Members have the right to submit written information or other materials for consideration with their grievance.

Authorized Representative: The member may authorize an individual of their choosing to represent or assist them in their appeal, including their practitioner. HAP Midwest Health Plan requires members to designate their representative in writing.

Administrator and Contact Person at HAP Midwest Health Plan: The contact person or designee for HAP Midwest Health Plan is the Grievances Coordinator.

Investigation: HAP Midwest Health Plan ensures a full and complete investigation of all grievances/appeals, including consideration of materials submitted by the member.

The Medicaid member has the right to request a fair hearing with the Michigan Department of Health and Human Services before, simultaneously with, or after they have utilized HAP Midwest Health Plan’s grievance and appeal procedure. However, if the member is requesting an external review based on an adverse determination, the member has only 90 days to request a State Fair Hearing. The member may request a hearing by calling (800) 642-3195 or in writing to:
  • Administrative Tribunal
  • Michigan Department of Health and Human Services
  • P.O. Box 30763
  • Lansing, MI 48909-7695
In addition, the member has the right to request a review by DIFS after they have exhausted HAP Midwest Health Plan’s internal appeal process. The member may request an external review by DIFS for the following circumstances:
  • If the member remains dissatisfied with the resolution outcomes from the appeal / grievance processes outlined in steps one (1) and two (2), he/she has the right to request an external review by DIFS. A member must exhaust HAP Midwest Health Plan’s internal grievance process prior to requesting an external review. If HAP Midwest Health Plan has not issued a written decision within the 35-day time frame and without the agreement of the covered person to a delay, the member may request an external review.
Not later than 60 days after the receipt of a final notice of a decision or an adverse determination from HAP Midwest Health Plan’s internal grievance/appeal process the member may file for an external review with the Commissioner of Financial and Insurance Services. For an external expedited review, the member must file with HAP Midwest Health Plan prior to filing with DIFS. This can be immediately after filing with HAP Midwest Health Plan, and the reviews can be concurrent
HOW TO FILE AN APPEAL
HAP Midwest Health Plan has a two-level internal member grievance/appeal process
Level 1 grievances/appeals are verbal or written member grievances which are resolved by customer service representatives with assistance from other departments when needed.

Level 2 grievances/appeals are for situations when the member is dissatisfied with the resolution of their Level 1 grievance/appeal.
An external review is available through DIFS when the member remains dissatisfied with the resolution of their Level 2 grievance. Members may also request a Medicaid Fair Hearing at any point during the review process.

Filing Grievance or Appeal: All members receive written information at the time of their enrollment with HAP Midwest Health Plan which outlines the process available to assist them with filing a grievance or an appeal. A member may file (or have filed on his/her behalf) a grievance verbally by calling the toll free (888) 654-2200 for HAP Midwest Health Plan. A member may also file a written grievance by documenting the issue and faxing it to (248) 663-3771, or visiting on site or mailing it directly to the Customer Services Department at the HAP Midwest Health Plan corporate office at:
  • HAP Midwest Health Plan
  • Attention: Customer Service Department
  • PO Box 2578
  • Detroit, MI 48202
HAP Midwest Health Plan Customer Services representatives are available to give enrollees assistance in completing forms and taking other procedural steps. HAP Midwest Health Plan provides interpreter services and TTY/TDD toll-free numbers. HAP Midwest Health Plan acknowledges receipt of each grievance in writing.

Filing Timeframes and Methods: All initial grievances/appeals must be filed up to 90 days of the member’s date of discovery of the problem, complaint or aggrieved situation. All appeals must be filed not more than 90 days after the date of HAP Midwest Health Plan's adverse determination. Grievances and appeals may be filed in writing, by telephone, or in person at HAP Midwest Health Plan’s corporate office. HAP Midwest Health Plan assists members to document their grievance or appeal request as needed. Members have the right to submit written information or other materials for consideration with their grievance.

Authorized Representative: The member may authorize an individual of their choosing to represent or assist them in their appeal, including their practitioner. HAP Midwest Health Plan requires members to designate their representative in writing.

Administrator and Contact Person at HAP Midwest Health Plan: The contact person or designee for HAP Midwest Health Plan is the Manager of Customer Services. The manager can be reached at (888) 654-2200, fax (248) 663-3771. If needed after normal business hours, the phones are answered by Team Health and this service can contact the manager. The Customer Services Manager also serves as the administrator and contact person for the DIFS.

Investigation: HAP Midwest Health Plan ensures a full and complete investigation of all grievances/appeals, including consideration of materials submitted by the member.

The Medicaid member has the right to request a fair hearing with the Michigan Department of Health and Human Services before, simultaneously with, or after they have utilized HAP Midwest Health Plan’s grievance and appeal procedure. However, if the member is requesting an external review based on an adverse determination, the member has only 90 days to request a State Fair Hearing. The member may request a hearing by calling (800) 642-3195 or in writing to:
  • Administrative Tribunal
  • Michigan Department of Health and Human Services
  • P.O. Box 30763
  • Lansing, MI 48909-7695
In addition, the member has the right to request a review by DIFS after they have exhausted HAP Midwest Health Plan’s internal appeal process. The member may request an external review by DIFS for the following circumstances:
  • If the member remains dissatisfied with the resolution outcomes from the appeal / grievance processes outlined in steps one (1) and two (2), he/she has the right to request an external review by DIFS. A member must exhaust HAP Midwest Health Plan’s internal grievance process prior to requesting an external review.
  • If HAP Midwest Health Plan has not issued a written decision within the 35-day time frame and without the agreement of the covered person to a delay, the member may request an external review.