If you’re appealing a decision about care you haven’t yet received:
- You may request either an expedited or a standard 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 may request an expedited appeal orally or in writing.
- You must request a standard appeal in writing.
- You must contact HAP within 65 days of receiving written notification of the denial.
- For standard appeals involving medical care, we’ll respond within 301 calendar days after we receive your request.
- For expedited appeals involving medical care, we’ll respond within 721 hours after we receive your request.
1The time to complete standard service and fast requests may be extended by up to 14 days if we need more information and the extension is in your best interest. If we take an extension, we’ll 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 also may request a 14-day extension if you need more time to provide us with additional information.
Where to file an appeal
You may file your appeal with our Customer Service department by one of the following methods:
By phone (expedited appeals only)
Call the customer service department for your plan:
HMOs
PPOs
HMO-POS
D-SNPs
C-SNP
- HAP Medicare Diabetes and Heart (HMO C-SNP): (800) 848-4844 (TTY: 711)
Our team members can take your call during the following times:
- 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)
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. Please don’t share personal health information when you leave your message.
By fax
(313) 664-5866
In writing
Health Alliance Plan
ATTN: Appeal and Grievance Department
1414 E. Maple Rd.
Troy, MI 48083
If you need to register for your online HAP account, have your ID card ready and go to hap.org/login. Click on Register now.
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 (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.
