Complaints & Appeals
Complaint and Appeals Process
McLaren Health Plan (MHP) Community wants you to be happy with the health care you receive. MHP Community has a process for you to voice your complaints about the health care you receive from our contracted doctors or services you receive from us.
Complaint/Grievance Procedure
At MHP Community , we want to hear your comments so that we can make our services better for our members. We want you to be able to receive answers to any questions that you have about MHP Community . We also want to provide you with ways of reaching fair solutions to any problems that you may have with MHP Community. When you have any comments or concerns, please call Customer Service at (888) 327‑0671 (TTY: 711).
Customer Service will assist you in documenting your complaint/grievance. We have thirty (30) calendar days to complete our investigation and resolution to your complaint/grievance. You will receive notification in writing within three (3) calendar days of the determination of the complaint/grievance.
Member Appeal Procedure
If MHP Community has decided to deny, terminate, or reduce any covered service, in whole or in part, you can file an appeal. If you want to request an appeal with MHP Community's Appeals Committee, you or your authorized representative must send an appeal request in writing within 180 calendar days of MHP Community's resolution to your complaint/grievance or denial of services. You can send your appeal request along with any additional information to:
McLaren Health Plan Community
Attn: Member Appeals
G-3245 Beecher Road
Flint, Michigan 48532
If you wish to have someone else act as your authorized representative to file your appeal, you will need to complete MHP's Authorized Representative Form, or you may call Customer Service at (888) 327‑0671 (TTY: 711) for a copy to be mailed to you.
MHP Community has thirty (30) calendar days to complete the internal appeal process for a pre-service appeal request, and sixty (60) days for a post-service appeal request. You will receive notification in writing within three (3) calendar days of the determination of the appeal. You may also request copies of information relevant to your appeal, free of charge, by contacting Customer Service at (888) 327‑0671 (TTY: 711).
If, after your appeal, we continue to deny payment, coverage, or the service requested, or you do not receive a timely decision, you can ask for an external appeal. You must do this within sixty (60) days of receiving MHP's appeal decision. MHP will provide the form required to file an external appeal. These requests should be mailed to:
Department of Insurance and Financial Services
Health Plan Division, Appeals Section
611 W. Ottawa St., Third Floor
P.O. Box 30220
Lansing, Michigan 48909-7720
Or call: (517) 373-0220; or (877) 999-6442 (toll free)
Or fax: (517) 284-8838
Expedited Complaint/Grievance or Appeal
If you (or another person, including a physician, who is authorized in writing to act on your behalf) believe that due to your medical status, resolution of your complaint/grievance and/or appeal within MHP Community's normal time frames would seriously jeopardize your life or health or ability to regain maximum function, the expedited complaint/grievance or appeals process may be utilized.
Expedited Complaint/Grievance or Appeals should be made by telephone by calling MHP at (888) 327‑0671 (TTY: 711).
MHP Community will make a determination concerning your expedited complaint/grievance or appeal and communicate that to you and your physician as expeditiously as the medical condition requires, but not later than seventy-two (72) hours after receipt. You and your physician will be provided with written confirmation of this determination within two (2) calendar days, following the verbal determination.