LifeWays is committed to you, our customer. You are our first concern and we value your feedback. If you want to let us know how we are doing, ask for a customer satisfaction card at any service location or at the Customer Services desk.
If you would like to be on an Advisory Council or otherwise participate in our quality efforts, please call Customer Services at 517.780.3332 or toll-free 866.630.3690.
To report concerns with fraud or abuse, please call the LifeWays Corporate Compliance Hotline at 517.789.2485 or the Mid-State Health Network Compliance Hotline at 1.844.793.1288.
Our goal is to provide you with the most appropriate services for your condition with the best quality of care possible. However, you have the right to say that you are unhappy with your services. You can do this by filing a grievance or an appeal.
What is the difference between a Grievance & an Appeal?
You would file a grievance if you are unhappy with the way your services are provided or how you are treated.
You would file an appeal if you have been denied a request for services or have received a decision that would reduce, suspend or terminate the services you are currently receiving, also known as an Adverse Benefit Determination.
What do I do if I have a grievance or appeal?
LifeWays has a customer-friendly process that allows you to advocate for your needs. Grievances and appeals can be filed orally or in writing by contacting LifeWays Customer Services. Simply request to file a grievance or start a “local appeal.” The Customer Service Specialist will assist you in completing the paperwork.
If you choose to file a grievance or appeal you will not be retaliated against in any way. Resolutions will be based upon regulatory allowances, medical necessity and consumer satisfaction and choice in accordance with treatment protocols.
For more information please contact Customer Services at 1.866.630.3690 or 517.780.3332.
Why would I file a grievance?
If you are ever not happy with the way your services are provided or how you are treated, you would file a grievance. Please, notify Customer Services of any disappointing experiences you may encounter within the Community Mental Health System, including network providers.
Who can file a grievance?
Grievances can be filed by anyone that has contact with the Community Mental Health System. This can include consumers, family members, providers, community members, guardians, etc.
Once the grievance form is done an acknowledgment letter is mailed to you within 5 calendar days. Your grievance is sent to the appropriate LifeWays employee to process and resolve your grievance.
Is it ever too late to file a grievance?
A grievance can be filed at any time.
How long will the grievance process take?
The grievance process may take up to ninety (90) calendar days for a resolution. But the LifeWays Customer Service Specialist understands this is an important part of your life and will try to resolve all grievances as quickly as your health condition requires. Once the grievance is resolved, Customer Services will notify you in writing of the resolution.
What if I do not agree with a decision made regarding my services?
You will be given notice when a decision is made that denies your request for services or reduces, suspends, or terminates the services you already receive. This is known as an Adverse Benefit Determination. You have the right to file an appeal when you do not agree with this decision.
Who can file a local appeal?
An appeal can be filed by you, your guardian, or an advocate of your choice simply by contacting LifeWays Customer Services.
You can name a relative, friend, attorney, doctor or someone else to act for you, call the Customer Service Department to learn how to name your representative. Both you and the person you want to act for you must sign and date a statement confirming this is what you want. You’ll need to mail or fax this statement to us. Keep a copy for your records.
Is it ever too late to file a local appeal?
Local appeals must be filed within sixty (60) calendar days from the date of denial notice. Any inquiries about filing an appeal will be treated as the filing date to establish the earliest possible filing date.
How long will the local appeal take?
The local appeal process may take up to 30 calendar days for resolution. But the LifeWays Customer Service Specialist understands this is an important part of your life and will try to resolve all appeals as quickly as your health condition requires.
You have a right to request an expedited or “faster” hearing if waiting for 30 calendar days for a standard appeal would seriously jeopardize your life, health or your ability to attain, maintain, or regain maximum function. If requested and accepted you will receive a response to your local appeal within 72 hours. If your request for an expedited appeal is denied, the appeal will continue with the 30 calendar day resolution period.
Once the appeal is resolved, Customer Services will notify you in writing of the resolution and your further appeal rights.
What is the difference between a local appeal and a state fair hearing?
A local appeal is presented to a LifeWays employee who has the clinical expertise to make a decision on your services but has not been a part of the decision so far.
A State Fair Hearing is an appeal that is presented to a neutral judge for a decision. This can only happen after receiving a local appeal decision.
Who can request a state fair hearing?
A state fair hearing can be requested by you, your guardian, or an advocate of your choice, just like the local appeal.
Is it ever too late to request a state fair hearing?
A state fair hearing must be requested within 120 calendar days from the date of local appeal decision.
How long will the state fair hearing process take?
The state fair hearing process may take up to 90 calendar days for resolution. You have a right to an expedited hearing for the same reasons as a local appeal. To request an expedited hearing, call the Michigan Administrative Hearing office toll free at 877.833.0870.
Will I still get services during this process?
If you asked for your benefit(s) to continue during the internal appeal process and want them to continue during the State Fair Hearing process, you must ask for the State Fair Hearing and Michigan Administrative Hearing System (MAHS) must receive your request within 12 calendar days of the date on the Notice of Appeal Decision. Also, the following must be true for your services to continue:
You may be required to repay the cost of the continued services if the original decision is upheld, you withdraw your appeal or hearing request, or you or your representative does not attend the hearing.
You have the right to get this information in a different format, such as audio, Braille, or large font due to special needs or in your language at no additional cost.
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