Appealing a Denial of Mental Health Services or Hospitalization
An individual has the right to request a second opinion from the Chief Executive Officer (CEO) of GHS. You may call the office at (810) 257-3707 to make a direct request. You may also put your request in writing and send it to:
Danis Russell, Chief Executive Officer
Genesee Health System
420 W. Fifth Avenue
Flint, MI 48503
Local Medicaid Appeal Process
If you have Medicaid, you can ask for a Local Appeal if there was an action taken or a proposed action was made about your services. If you disagree with the action, you need to make the request for appeal within 45 (calendar) days of the date of the notice. If you want your services to stay the same while the action is being appealed, you need to make the request within 12 (calendar) days of the notice. You may contact either the GHS Due Process office at (810)424-6065, or the Customer Services Department at (810) 257-3705, Toll Free (877) 346-3648, or TTY (810) 257-1346.
State Level Appeal (Medicaid Fair Hearing)
If you have Medicaid and you disagree with a decision that was made about the services paid for by Medicaid, you can appeal the decision in the following situations (described as "actions"):
- Denial or limited authorization of a requested service
- Reduction, termination, suspension of a previously authorized service; or Denial of a payment for service
- Failure to make an authorization decision within 14 (calendar) days-standard; within three (working) days-expedited
- Failure to provide services within 14 days (calendar) of agreed-upon date
- Failure to act on a request for appeal within 45 (calendar) days-standard; within three (working) days-expedited
- Failure to provide disposition of a grievance within 60 (calendar) days
You should receive a written notice telling you about one of the types of action listed above. You have up to 90 (calendar) days from the date of the notice to file a Medicaid Fair Hearing. If you file the appeal before the date the services are scheduled to change, or within 12 (calendar) days of receiving the letter, services may stay the same if you request that they remain the same until the outcome of the hearing. To use this type of appeal, fill out the “Request for Hearing” form that came with your notice letter. You can contact the Administrative Tribunal at the Office of Administrative Hearings & Appeals for assistance at 1-(877) 833-0870. If you would like help from GHS, the Customer Services Department can be reached at (810) 257-3705, Toll Free (877) 346-3648, TTY (810) 257-1346); or you can contact the GHS Due Process Office at (810) 424-6065.
Local Non-Medicaid Appeal
If you do not have Medicaid and an action is taken as described above, you can request a local appeal by calling the Due Process Office at (810) 424-6065 or by calling Customer Services for assistance at one of the numbers above. If you are not satisfied with the way GHS settles the case, you can ask MDCH to review the matter. This is called the "Alternative Dispute Resolution Process."