A grievance is a complaint, either written or oral, expressing dissatisfaction with the services or the quality of your care provided by Great Lakes PACE. You may file a grievance with any PACE staff member at any time. Grievances can be filed in person, fax, mail, or telephone. To file a grievance by telephone or for status updates and process questions regarding a filed grievance, please contact our Quality Manager at (989) 272-7610. Or you may deliver in person or by mail to: Quality Manager, Great Lakes PACE, 3378 Fashion Square Blvd, Saginaw, MI 48603
Appointing Someone To Help You File A Grievance or Appeal
If you would like to appoint a person to file a grievance or request an appeal on your behalf, you and the person accepting the appointment must complete the CMS Appointment of Representative Form (or a written equivalent) and submit it with the request.
- Access the CMS Appointment of Representative Form in English
CMS Appointment of Representative Form in English – form will open in a new window - Access the CMS Appointment of Representative Form in SpanishCMS Appointment of Representative Form in Spanish – form will open in a new window
- Access the LP Appointment of Representative Form in EnglishLP Appointment of Representative Form in English – form will open in a new window
- Access the LP Appointment of Representative Form in SpanishLP Appointment of Representative Form in Spanish – form will open in a new window
If You Are Not Satisfied With The Result
You or your representative have the right to request an appeal of Great Lakes PACE’s decision. If PACE denies a request for services or payment or reduces your services, you will receive written information about the denial and how to file an appeal. There are two types of appeals: internal and external through the Medicare and/or Medicaid appeals process.
Internal appeals. These appeals are received either verbally or by writing to Great Lakes PACE. An appeal must be submitted within 30 days from the day that you are notified that your request has been discontinued, reduced, or denied. Until you receive notice of a final decision, you may choose to continue to receive any services in question, but you may have to pay for these services if the final decision is not in your favor. You also have the right to file an appeal with the State of Michigan at the same time of filing through Great Lakes PACE. You have the right to request an expedited appeal.
External Appeals. You can file an external appeal to either Medicare or Medicaid, but not both. At your request, PACE staff will assist you with an external appeal. To appeal to Medicaid, you may contact: Michigan Administrative Hearing System, PO Box 30763, Lansing, MI 48909. (877) 833-0870
Regarding filing an appeal with Medicare, you need to first go through the Great Lakes PACE Central Michigan appeal process. Great Lakes PACE staff will help file with Medicare if that is your choice.
