Michigan

STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. By Michigan law, each health plan must establish a grievance process. Follow the steps below to file a complaint and grievance with your health plan:

• First contact your health plan with your complaint and ask them to provide a written response.
• If you do not agree with your health plan’s initial response, file a written complaint with the Department of Insurance and Financial Services, Office of Consumer Services here or call the helpline: (877) 999-6442.
• Consumer Services then acts as a link between you and your health plan to resolve the complaint.
• If the complaint is not resolved, submit a written grievance to your health plan here.
• Your health plan is required to complete all steps in the grievance process within 35 days after you submit your written request.
• Your health plan can request an additional 10 days to obtain necessary medical information only if you agree to the delay.

Below are links to the complaint forms for Michigan’s top health plans:

• Aetna Better Health of Michigan
• Michigan Complete Health (formerly Fidelis Secure Care)
• HAP Empowered
• Health Alliance Plan of Michigan
• McLaren Health Plan
• Molina Healthcare of Michigan
• Paramount Care of Michigan
• Physicians Health Plan
• Priority Health
• Total Heath Care
• UnitedHealthCare
  • Log on to MyUHC.com and complete the “Appeals and Grievance Form”
  • Select: Claims and Accounts > Medical Appeals and Grievances > Member Service Request Form
  • Fax or mail the completed form to the UnitedHealthcare address listed in the instructions
• Upper Peninsula Health Plan
• My plan isn’t listed

Medicare Plans

 

STEP TWO – File a Complaint

You have the right to file a complaint with the Department of Insurance and Financial Services (DIFS) if you have a problem getting the services you need, including quality and affordable health care. To file a complaint you must first complete your health plan’s grievance process.

• File a complaint with the DIFS here.

After completing the grievance process with your health plan, you can request an External Review through the Patient’s Right to Independent Review Act (PRIRA).

• Request an External Review through the PRIRA here.
• Find more information on the PRIRA process here or call DIFS: (877) 888-6442.