An appeal is a request for a review of a decision Recovery Pathways, LLC or their contracted providers’ makes about your services 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 Jeanne L. Diver, MPA Customer Service & Rights Specialist for the Mid-State Health Network at 517-657-3011. You have 45 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 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 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 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 days you can file for a Medicaid State Fair Hearing.
A grievance is an action you can file about a concern, question or complaint about services provided by your mental health or substance abuse 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.
Once a grievance is filed, you will receive an acknowledgement letter within 5 days. You will also receive a letter telling you the decision made about the grievance. This letter will be mailed in no more than 60 days. If you receive Medicaid and get a Disposition letter after the 60 days will have the right to file for a State Medicaid hearing.
Michigan Department of Health and Human Services (MDHHS) Alternative Dispute Resolution
This is available to people without Medicaid who are unhappy with the local appeal process. If you do not agree with an appeal decision made within our local process. You have 10 days from when you get the written notice to file for a MDHHS Alternative Dispute Resolution.
You may contact Customer Services at 989-928-3566 or send a written request to:
Michigan Department of Health and Human Services
Division of Program Development, Consultation and Contracts
Bureau of Community Mental Health Services
ATTN: Request for DHHS Level Dispute Resolution
Lewis Cass Building
320 S. Walnut St.
Lansing, MI 48913