HAP

Grievances

You have the right to make a complaint if you have concerns
or problems related to your coverage or care.

What is a grievance?

A grievance is a type of complaint you make about us or one of our network providers or pharmacies. For example, you could file a complaint if you are having a problem with such things as the quality of your care, waiting times for appointments or the cleanliness or condition of your doctor's office. These types of complaints do not involve coverage or payment disputes.

For complaints about a decision we've made to deny a request for coverage of health care services or prescription drugs or payment for services or drugs you already received, you need to file an appeal.

If you file a grievance, we will 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 will automatically give you an “expedited grievance”. If you have an “expedited grievance,” we will give you a response within 24 hours. Please contact Customer Service for information about filing an “expedited grievance”.

How to file a 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:

By phone:

HAP Senior Plus (HMO, HMO-POS) Customer Service
(313) 664-7015 or (800) 801-1770 toll-free
TTY: 711

HAP Senior Plus (PPO) Customer Service
(313) 664-9050 or (888) 658-2536 toll-free
TTY: 711

Office hours:
Monday through Friday, 8 a.m. to 8 p.m.
Saturday, 8 a.m. to noon.
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.

Extended hours from Oct. 1 through Feb. 14: seven days a week, 8 a.m. to 8 p.m.
We will be open on Saturdays, from 8 a.m. until 12:00 p.m., from February 15 through March 31



By fax:
(313) 664-5866

In writing:
Health Alliance Plan
ATTN: Appeal and Grievance Department
2850 W. Grand Boulevard
Detroit, MI 48202

By email
msweb1@hap.org

Quality of care issues
If you are concerned about the quality of care you received, including care during a hospital stay, you can also complain to an independent organization called KEPRO.

You can write or call KEPRO at:
KEPRO
5201 West Kennedy Blvd, Suite 900
Tampa, FL, 33609
(855) 408-8557

Appointing a representative.

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, then you and that person must sign and date the Appointment of Representative form (PDF) and then mail the completed form to the Customer Service address above.

You must have Adobe Reader to download PDF files. Download for free. (You are leaving a Medicare-approved site)

Have questions?

HAP can help! Send us an email or give us a call. 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 may also 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 (You are leaving a Medicare-approved site) . The Office of the Medicare Ombudsman (OMO) (You are leaving a Medicare-approved site) can help you.

 
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