How to file a grievance
You have the right to make a complaint if you have concerns or are unhappy with your coverage or care.
Step 1: Call McLaren Medicare Member Services at 833-358-2404 to file a complaint.
- If you do not wish to call (or you called and were not satisfied), you can put your complaint in writing and send it to us. If you put your complaint in writing, we will respond to your complaint in writing.
- You or your representative can submit a grievance:
By Mail:
McLaren Medicare
Attn: Appeals & Grievances
PO Box 710
Flint, MI 48501-9900
By Fax: 810-962-8173
By Email: medicareappeals@mclaren.org
Standard grievances are processed as quickly as your health requires, but no later than 30 calendar days from receipt. We may extend the time frame by up to 14 calendar days if you ask for an extension or if we need additional information and delaying our response is in your best interest. Grievances received orally will be responded to orally. If the grievance is submitted in writing, we will respond in writing with our decision. All grievances must be submitted within 60 calendar days of the event or incident. Any grievance submitted outside this time frame cannot be accepted.
You or your representative may request an expedited grievance if we extend the time frame to make an organization or coverage determination, extend the timeframe to make a reconsideration or redetermination, deny your request for an expedited appeal, or deny your request for an expedited organization determination. If you wish to file an expedited grievance, contact Member Services. Expedited grievances will be responded to verbally within 24 hours of receipt.
If upon review of your expedited request we see that delaying our decision will not seriously harm you medically, we will not accept the expedited request. We will handle the request as a standard grievance and process within 30 days of receipt. We will notify you of this decision verbally and a written notice will be mailed within three (3) calendar days after the verbal notification.
The deadline for making a complaint is 60 calendar days from the time you had the problem you want to complain about.
Step 2: We will review your complaint and give you an answer
- If possible, we will answer you right away. If you call us with a complaint, we may be able to give you an answer on the same phone call.
- Most complaints are answered within 30 calendar days. If we need more information and the delay is in your best interest or if you ask for more time, we can take up to 14 more calendar days (44 calendar days total) to answer your complaint. If we decide to take extra days, we will tell you in writing.
- If you are making a complaint because we denied your request for a fast coverage decision or a fast appeal, we will automatically give you a fast complaint. If you have a fast complaint, it means we will give you an answer within 24 hours.
- If we do not agree with some or all of your complaint or don’t take responsibility for the problem you are complaining about, we will include our reasons in our response to you.
For more information on filing a grievance, please see your Evidence of Coverage.
How to file an appeal
If your request for coverage or payment have been denied, you have the right to file an appeal with us.
If we have denied a request for coverage for your medical care, you can submit an appeal to us within 65 days of receiving the written denial notice from us.
To submit a standard appeal, mail your written request to:
McLaren Medicare
Attn: Appeals & Grievances
PO Box 710
Flint, MI 48501-9900
Or you can call McLaren Medicare Member Services at 833-358-2404.
We will review your appeal and give you an answer within:
- 30 calendar days after receiving your standard appeal request
- 7 calendar days after receiving your appeal request regarding a Part B drug, or
- 72 hours of receiving your fast appeal request.
If we deny all or part of your appeal, we will automatically send the appeal to an independent review organization for additional review.
For more information on filing an appeal, please see your Evidence of Coverage.
How to file an appeal regarding the Medicare Prescription Payment Plan
If you believe there has been a mistake regarding the Medicare Prescription Payment Plan, please contact 844-336-2678 for additional information on how to submit an appeal or grievance.
We will review your appeal about your prescription drug benefits and give you an answer within:
- within 7 calendar days for a standard appeal
- within 72 hours for a fast appeal request
How to Appoint a Representative
You have the right to have someone act on your behalf when you need help with filing an appeal or grievance or when making a coverage request. This person is called your appointed representative. Your appointed representative can be a relative, friend, or any other person you want to file an appeal or grievance or submit a coverage request for you.
To name someone to be your appointed representative, you must fill out and sign an Appointment of Representative form or provide us with the equivalent information. To get the form call Member Services at 833-358-2404 (TTY: 711) and ask for the Appointment of Representative form or download and print the Appointment of Representative form from the Medicare website.
Once you have the form, you must complete it and both you and your appointed representative must sign. Completed, signed forms are valid for one year or for the duration of the individual appeal, grievance or coverage request if longer than one year.
You can mail the completed form to:
McLaren Medicare
Attn: Appeals & Grievances
PO Box 710
Flint, MI 48501-9900