We encourage your comments so that we can continue to improve our service to you. While we hope that there are no problems with our service, sometimes, one may happen.

If Physicians Health Plan makes a decision you disagree with, you have the right to appeal that decision. Your appeal is called a "Grievance." We have a Grievance process to resolve your issue fairly and quickly.

How to File a Grievance:

1. Contact the Customer Service Department.

• If you have a question or concern, call PHP’s Customer Service Department at the telephone number on the back of your PHP ID card. We will try to answer your question and solve your problem right away.

2. If you are not happy with our decision, you may file a formal Grievance.

• If you are unhappy with the outcome of your issue, you have the right to appeal our decision by filing a Grievance. A Grievance must be in writing. You can either write a letter or use the PHP Grievance Form. Customer Service can send you a Grievance Form, if you need it.
• We will let you know that we received your Grievance letter or form within 5 days from the date we receive it. Your issue will be reviewed. If we change our decision, we will let you know in writing. If we do not change our decision, we will invite you to attend a Grievance Hearing. If a hearing is needed, we will tell you the date and time of the hearing at least one week before the hearing date.
• We will appoint a special committee to hear your issue. If you want someone to attend the hearing for you, you must let us know that in writing a week before the hearing date so we can complete the needed paperwork to allow that person to represent you.
• You and/or your authorized representative have the right to present additional information at the hearing. You or your representative may attend in person, or by telephone, or may choose to not attend.
• If you cannot attend on the date scheduled, you may reschedule. You should contact us by telephone to let us know and arrange a new date. We will ask you to send your request in writing. We must receive your request in writing before the scheduled hearing date. If we do not, we will make a final decision about your issue at the scheduled hearing time using all information available at that time.
• The PHP Grievance process should be completed within 30 days. We will mail you a letter with a final decision within 30 days from the date we received your written grievance. It should not be longer than 30 days unless you asked to change the date of the hearing.

3. What to do if you are unhappy with our Final Decision about your Issue.

If you are not happy with our final decision, you have the right to seek external review with the State of Michigan, Office of Financial and Insurance Regulation (OFIR). You must send your request for external review within 60 days from the date you receive PHP’s final decision. You must finish the PHP Grievance process before asking for external review, unless there is an urgent situation.

We will provide you a copy of the OFIR Request for External Review Form. For more information, you may contact the Commissioner at the address provided below.

4. There are Exceptions for Urgent Situations.

If a physician believes your issue is urgent due to a risk to your life or health, there is a quicker process to resolve your issue.

• The Doctor needs to notify PHP, verbally or in writing, to confirm that an urgent situation exists.
• PHP will tell you and your doctor of our final decision with 72 hours after the doctor notifies PHP of the urgent request. If our initial decision is not in writing, we will put it in writing no later than two business days after telling it to you.
• For urgent situations, you may ask for an external review at the same time you go through the PHP Grievance process. For more information about requesting a review of an urgent situation by the Insurance Commissioner, contact this address:

  Office of Financial and Insurance Regulation Division of Insurance, Health Plan Division 611 West Ottawa, 3rd Floor P.O. Box 30220 Lansing, MI 48933 Telephone: 877-999-6442 http://www.michigan.gov/dleg/