Appeals and Grievances

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Appeals – Call the Recipient Rights/Customer Services Department – 989-928-3566 –  for help

An appeal is a request for a review of a decision Recovery Pathways, LLC or their contracted providers have made about your services that you do not like. (Terminate, reduce, suspend or deny). Anytime you disagree with Recovery Pathways, LLC or a contracted provider when they make a decision to deny, suspend, end or reduce your current services (or a service you have requested) you can file an appeal by contacting the Recipient Rights/Customer Services at 989-928-3566. You have 45 calendar days from the date listed at the top of the Notice letter (which is sent to let you know about the decision to deny, suspend, end, or reduce treatment services) to file an appeal. The appeal process will not use anyone who was part of making the first decision.

You can ask for a quick appeal (expedited) if waiting 45 calendar days for a decision could cause you serious harm. The quick appeal will give you an answer within three business days. You can also ask for a medical second opinion if you are denied services.

Once you file an appeal you will receive an acknowledgement letter in the mail within five business days of filing a standard appeal. You will receive a letter telling you of the results of your appeal (called a disposition letter) within 45 calendar days of filing the appeal. During the appeal you can ask to see what information was used to make the decision and you can give us any information you think will help in making the best decision about your services. If you are not told of a decision within 45 calendar days you can file for a Medicaid State Fair Hearing.

Grievances

A grievance is an action you can file about a concern, question or complaint about services provided by your mental health or substance use disorder service provider. You can file a grievance at any time about anything. Someone else, such as a provider, can file a grievance for you as long as they have written consent to do so.

To file a grievance call the Recipient Rights/Customer Services Department at 989-928-3566.

Once a grievance is filed, you will receive an acknowledgement letter within five business days. You will also receive a letter telling you the decision made about the grievance. This letter will be mailed within 60 calendar days.   If you receive Medicaid and get a Disposition letter after the 60 calendar days you will have the right to file for a State Medicaid hearing.