Grievance & Appeals
Due Process
Grievances and Appeals are crucial to any organization's operation. This area offers members or authorized representatives a chance to express dissatisfaction with a service they've received or to challenge a decision that negatively impacts the services they requested or obtained.
Grievance
A grievance is an expression of dissatisfaction about any aspect of care or service provided that doesn't involve an adverse determination. You have the right to say you are unhappy with the services you are receiving, the staff providing the services or the manner services are being provided. You can file a grievance by phone, in person or in writing at any time. Medicaid and non-Medicaid grievances can be filed at any time. MI Health Link grievances must be filed within 60 days of the incident. If you need help filing a grievance, our Customer Service Grievance staff is available to help you. Some examples of grievances are:
- Waiting too long get an appointment or to be seen by your doctor, therapist, or case manager;
- The care you received not being good enough
- Not feeling welcomed
- Poor customer service
We take all grievances seriously and respond to them timely. You will receive a letter acknowledging your grievance between three calendar to five business days depending upon your insurance type. We investigate and resolve grievances within 30 to 90 calendar days. Grievances are resolved as quickly as possible. DWIHN staff can assist you.
If you want someone else to file a grievance on your behalf, they can. However, we will need a statement in writing that you are giving someone else permission to speak on your behalf. Without the written statement, we can't accept the grievance from someone else.
We can assist you with filing a grievance by contacting us at:
DWIHN Customer Service
707 Milwaukee St. Detroit, MI 48202
Hours: 8:00 a.m. - 4:30 p.m.
Local: 313-344-9099
Toll-Free: (888) 490-9698 TTY: 711
Email: pihpgrievances@dwmha.com
You will receive information about grievances, appeals and other due process rights when you first begin services with DWIHN. You will also receive information each year or as you request it. You can get this information at any time by contacting the DWIHN Customer Service office.
Appeals
A local appeal is your right to ask for a review of a decision made to delay, deny, reduce, suspend, or terminate a service you have asked for or are receiving. DWIHN or your provider must tell you when there is a change in a service you are getting or you have requested in writing. You can start an appeal by calling us or submitting a request to us in writing. Medicaid members have 60 calendar days to ask for a local appeal. MI Health Link members have 65 calendar days to request an appeal. Members who do not have Medicaid have 30 calendar days to ask for a local dispute resolution. DWIHN Member Appeal staff have 30 calendar days to give a decision for a standard appeal. If the service in question could harm the member's way of life by not receiving it, a fast appeal will be considered. Fast appeals are decided within 72 hours of receipt.
If you are a Medicaid or MI Health Link member and are not happy with the appeal decision, you can request a State Fair Hearing. You must make this request within 120 calendar days from the appeal decision in writing. For non-Medicaid members, you have 10 calendar days to ask for an alternative dispute resolution.
Your satisfaction is important to us. We are here to help with any problems or questions you have about your services. Just give us a call, we can assist you with:
- Appeals
- State Fair Hearing
- Local Dispute Resolution
- Alternative Dispute Resolution
- Mediation
If you have questions about any member appeals:
please call us at (313) 344-9099 or (888) 490-9698 and ask for the Member Appeals.
You can also email us at pihpmemberappeals@dwihn.org.