Complaint and Grievance Procedures
Complaint Procedure
University of Michigan Health Plan (UM Health Plan) works hard to bring you a positive health care experience. We value your insight, and encourage you to report any problems, questions, or concerns that you have with the services you receive. Contact Customer Service right away to assist you with any of the following concerns:
- Benefits (including services determined to be experimental, investigational, or not medically necessary/appropriate)
- Eligibility
- Payment of claims (in whole or in part)
- How we've handled payment or coordination of health care services
- Contracts with our health care providers
- Availability of care or providers
- Delivery or quality of health care services you received
Customer Service can be reached from 8:30 a.m. to 5:30 p.m., ET, Monday - Friday, excluding major holidays. You can find the number to call on the back of your member ID card, or you can submit a secure message to UofMHealthPlan.org/Contact-UofMHealthPlan.
The next step, if Customer Service is not able to resolve your concern, would be to submit a request to us in writing.
- Send us a written complaint via paper mail.
- Obtain a Quality of Service or Care Form from the Member Reference Desk.
- Have our Customer Service paper mail or email the Quality of Service orCare Form to you.
Please send the completed complaint to UM Health Plan in one of the following ways:
Via Mail:
University of Michigan Health Plan
Attn: Complaints
PO Box 30377
Lansing, Michigan 48912
Fax: 517-364-8517
Secure Message: UofMHealthPlan.org/Contact-UofMHealthPlan
If you still feel your concern has not been resolved, the next step would be to file a complaint with the Department of Insurance and Financial Services (DIFS). Contact the DIFS Office of Consumer Services with questions at 877-999-6442, Monday through Friday, from 8 a.m. to 5 p.m. You can also file a written complaint by completing the DIFS complaint form, located on the DIFS website at https://difs.state.mi.us/Complaints/
You may also mail your complaint to:
DIFS – Office of Consumer Services
P.O. Box 30220
Lansing, MI 48909-7720
Fax: 517-284-8837
Email: difs-hicap@michigan.gov
Grievance Procedure
You can appeal a decision that adversely impacts your coverage, including benefit and eligibility determinations. We call this appeal a "grievance". UM Health Plan follows the State of Michigan and U.S. Department of Labor Regulations with respect to resolving Appeal/Grievance issues. Customer Service can assist you in filing a grievance, and is also available to answer any questions you have about the grievance process.
How to File a Grievance
If you believe your situation is urgent, you may request an expedited appeal by faxing or emailing us your request. You may also request an external review at the same time through the Department of Insurance and Financial Services (DIFS), if your plan has DIFS rights. The address and telephone number are below:
By mail:
DIFS - Office of General Counsel - Appeals Section
PO Box 30220
Lansing MI 48909-7720
By courier or delivery:
DIFS - Office of General Counsel - Appeals Section
530 W Allegan St, 7th Floor
Lansing, MI 48933
Telephone: 877-999-6442
Fax: 517-284-8838
http://www.michigan.gov/difs/
