Asking us to Reconsider a Decision
We understand that you may disagree with a decision that we make. We make decisions about resolving complaints and we make decisions about authorizing coverage for care or treatment. When we make these decisions, we make every effort to avoid disagreements. If you do not agree with our decision, you may appeal.
We will tell you about how to appeal decisions we make as part of the resolution process. This includes how to appeal our decisions that might have a negative impact on your coverage or benefits or our relationship. An appeal is your request to us to change our decision about a complaint resolution or coverage for care or treatment issue.
If you are unhappy with the decision, call, write, or fax us your appeal.
Behavioral Health Professionals, Inc.
1333 Brewery Park Blvd, Suite 300
Detroit, MI 48207
Phone: 833-355-BHPI (2474)
Fax Number: 313-656-2588
If you need language assistance to help you file an appeal, please let us know. We will provide language assistance at no cost to you. We have bilingual staff and an interpreter service available for the entire process. Upon request, we can provide oral interpretation of documents written in English into your preferred language or translation of written documents into your preferred language. Finding the best way to resolve your appeal is an important part of our quality improvement program, and we will investigate the issues thoroughly.
The staff involved in the investigation will not be the same as the individual(s) who made the first decision. We determine the best people to investigate an appeal based on the nature of the appeal. The Complaints and Appeals Coordinator will oversee the process. When appeals are of a clinical nature, an appeal reviewer(s) who is a clinician and who was not involved in the original decision investigates the issues and proposes a resolution.
We propose resolutions to routine appeals within 30 calendar days and notify you of the decision. We propose resolutions to clinically urgent appeals within 72 hours and notify you of the decision. For appeals of proposed complaint resolutions, the appeal decision is final and there is no second level of appeal.