We want you to be happy as a member. If you have a question or problem, call us at 1-800-332-9161. We will try to answer your question on the phone. If not, we will try to solve the problem within two days. If you are not happy with the results or with any decision made by HealthPlus Partners, you or someone you choose to help you can file a grievance. We will assist you in filing the grievance if needed.
Start by contacting us by choosing one of the options below:
If you are still not pleased or if we have not contacted you within fifteen (15) calendar days from filing your grievance under Stage Two, you can appeal by writing or calling:
Office of Financial and Insurance Regulation
Division of Insurance
Health Plans Division
611 Ottawa, Second Floor
PO Box, 30220
Lansing, MI 48909-7720
(517) 335-2057 or
1-877-999-6442 (toll free)
If you ask for an external review, you have given us permission to share your health information including the medical record, if needed, for the review.
If we have made an adverse determination - meaning we reduced, denied or ended a service - you must ask for the external review within sixty (60) calendar days of being told of that your grievance was denied.
If your request for a review is approved, OFIR will either review your case or have an Independent Review Group (IRO) review your case. Both you and HealthPlus Partners may give this group any information about your case.
This group will make a recommendation to OFIR within fourteen (14) calendar days. OFIR then has seven (7) working days to make a final decision.
If your request for review does not involve an adverse determination, OFIR may assign staff to review your case. Within fourteen (14) calendar days, a recommendation will be made.
An expedited grievance can be requested if you believe that following the HealthPlus Partners’ normal time frames would seriously harm your health or life. You may request this or you may give written approval for someone else to act on your behalf. You can only ask for an expedited process if we have denied a request for services before you receive the service.
We will decide if the facts about your issue need to be addressed by this process. If not, we will use the normal process.
We will inform you of the decision about your grievance within seventy-two (72) hours after we receive it. You and your doctor will receive the decision in writing within two (2) calendar days of any oral decision. If you are not satisfied with our decision, you can file an appeal within ten (10) calendar days.
If your doctor believes that following the time frames in our expedited process would seriously harm your health or life and you have asked us to follow the expedited process, you may request an expedited external review from OFIR.
OFIR may decide to send this to the review group. This group may decide that you do not have to wait for us to make a decision. If so, they will review your case and make a recommendation within thirty-six (36) hours. You will be notified within twenty-four (24) hours of the completed review, of OFIR's decision.
You have the right to file a complaint with the state before or at the same time as filing one with HealthPlus Partners. You must request a hearing within 90 days of the initial denial decision. However, we hope that you will give us a chance to resolve the problem. If you decide to file with the state, follow these five stages:
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