What should I do if I would like to file a grievance?
A grievance is a complaint you let Delta Dental know about. It may be about dissatisfaction with a dental provider, the Healthy Michigan Plan or Medicaid program or Delta Dental. If you would like to file a grievance (also called a complaint), you can call customer service at 866-558-0280, or send your grievance in writing to:
Delta Dental
Attn: Medicaid Appeals
P.O. Box 9230
Farmington Hills, MI 48333-9230
Ph: 1-866-558-0280 (TTY users call 711).
What should I do if I would like to appeal an adverse benefit determination?
You have the right to ask Delta Dental for an Internal Appeal within 60 calendar days of the date on the adverse benefit determination. We can give you more time if you have a good reason for missing the deadline.
If we are stopping or reducing a service, you can keep getting the service while your case is being reviewed. If you want to continue services while your case is under review, you must ask for an internal appeal within 10 calendar days of the date of the adverse benefit determination or before the service is stopped or reduced, whichever is later. You could be responsible for the cost of services if our decision is upheld. You can ask for this internal appeal by calling customer service at 866-558-0280 or send your appeal in writing to:
Delta Dental
Attn: Medicaid Appeals
P.O. Box 9230
Farmington Hills, MI 48333-9230
You can ask to see, free of charge, all documents, records, and other information used to make our decision before or during the appeal. At no cost to you, you can also ask for a copy of the guidelines we used to make our decision.
What happens next?
If you ask for an internal appeal, we will give you a written decision within 30 calendar days. If we uphold our decision or you do not receive a timely decision, you can ask for a Medicaid State Fair Hearing from the Michigan Office of Administrative Hearings and Rules (MOAHR). You can also ask for an external review under the Patient Right to Independent Review Act (PRIRA) from the Michigan Department of Insurance and Financial Services. Your written decision will give you instructions on how to request a State Fair Hearing and external review.
How do I ask for an expedited appeal?
If you have an urgent situation where taking the time for a standard internal appeal could seriously jeopardize your life, health, or ability to attain, maintain, or regain maximum function, you can request an expedited (fast) appeal by calling our customer service number. If the situation is urgent and requires an expedited appeal, we will respond within 72 hours.
How does someone else act on my behalf?
When you appeal, you can name a relative, friend, attorney, doctor, or someone else to act as your representative. Both you and the person you want to act for you must sign and date a statement confirming this is what you want. You will need to mail or fax this statement to us with your appeal. Keep a copy for your records.
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