IMPORTANT NO TICE
Your appeal rights
You can resolve most quesons about our payment decisions by calling our Member Service Center at 800.336.0013 or
TTY 888.445.5614. If you sll have concerns, you have the right to le a grievance with us and to request an external
review with the Department of Insurance and Financial Services. We briey explain these procedures below. For
further details regarding the grievance process, call our Legal and Compliance Department at 800.742.2328 or visit our
website at www.messa.org.
MESSA Grievance Procedure
Write to us to tell us why you disagree with our decision. You must complete our standard grievance procedure
before you can request an external review. Please include your enrollee idencaon number, dayme telephone
number, date of service and any informaon that might support your posion. If you want another person, including
a physician, to act on your behalf during this grievance procedure, please include wrien authorizaon. Mail your
grievance to:
Associate Manager, Legal and Compliance
MESSA
1475 Kendale Blvd., P.O. Box 2560
East Lansing, MI 48826-2560
If you disagreed with our decision not to preapprove a service, we will send our nal wrien determinaon within 15
days of the date we received your grievance. If you disagreed with our claim denial or payment decision, we will send
our nal wrien determinaon within 30 days of the date we received your grievance. These periods suspend for any
me you take to respond to us. In both cases, you have the right to allow us addional me and we are allowed 10
addional days if we need more informaon from your healthcare provider. If you sll disagree with our decision, you
may request an informal managerial-level conference to discuss your grievance with us.
External Review Procedure
If our response doesn’t sasfy you, or if we don’t respond within 30 days regarding a preapproved service or 60 days
regarding a claim denial or payment decision, you can request an external review with the Department of Insurance
and Financial Services. You must request this review in wring within 120 days of receiving our nal determinaon.
You will have to authorize the release of protected health informaon during this external review. The Department’s
decision is final.
1475 Kendale Blvd., P.O. Box 2560 East Lansing, Michigan 48826-2560 517.332.2581 800.292.4910