To Report Problems and Appeal Decisions

Reporting Problems to the Upper Peninsula Health Plan

If you are not happy with the Upper Peninsula Health Plan (UPHP) or your health care, call Customer Service at 1-800-835-2556.  The Customer Service staff will listen to you and try to answer your questions or solve your problem.  You may also write a letter to Customer Service.  If you want help to write a letter, call Customer Service.  All letters should be sent to:

UPHP Customer Service
853 West Washington Street
Marquette, MI 49855

If your problem is not fixed at the time you call or write, Customer Service will look into your concern and get back to you within 5 business days.  A final decision will be made 30 days after we get your call or letter.  If you do not like the way we took care of your problem, you have 90 days to let us know.  We will tell you in writing of your rights and the steps for appeal.

To Appeal Medical Decisions

Approving care your doctor asks for is based on medical need.  UPHP does not reward providers for denying care or under-using services.

If you are not happy with a medical decision by UPHP, you may ask for an appeal.  You will learn in writing that UPHP has received your request within 5  days of receipt.  UPHP will review your appeal.  You will have a final decision in writing within 30 days.

If a 30-day timeline would be a serious threat to your life or health, your primary care provider (PCP) or another provider must call UPHP Clinical Services at 1-800-835-2556 and ask for an expedited appeal.  You will get a first decision within 72 hours.

You must give written consent for someone to act for you in an appeal.

Appointment of Representative Form

To Report Problems to the State

If you want to appeal a decision about medical need, and you have finished the UPHP grievance and appeal process, you may also do so, within 127 days of receiving our final decision by writing to:

Department of Insurance and Financial Services
Office of General Counsel-Appeals Section
P.O. Box 30220
Lansing, MI 48909-7720
Courier/Delivery: 530 W. Allegan Street, 7th Floor Lansing, MI 48933

Phone: 1-877-999-6442

Fax: 517-284-8838

Email: DIFS-HealthAppeal@michigan.gov

Online: https://difs.state.mi.us/Complaints/ExternalReview.aspx

You may also request a State Fair Hearing with the Michigan Administrative Hearing System (MAHS). You may request this hearing only after receiving notice that UPHP upheld our previous decision. You have 120 days from the date of our decision to request a State Fair Hearing. Forms will be included in the appeal denial notice. You may also call UPHP Customer Service to get the form you need to ask for a state fair hearing. To appeal, please write to:

Michigan Department of Health and Human Services
Michigan Administrative Hearing System
P.O. Box 30763
Lansing, MI 48909

Phone: 1-800-648-3397
Fax: (517) 763-0146

If you need help with the appeal process, call UPHP Customer Service at 1-800-835-2556 (TTY: 711).


Page Last Updated: 04/22/2019