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currently pending CMS review

Last Updated 2/13/2019

© 2018 by Great Lakes PACE.

Call us today on 1-844-445-7223

Q&A’s

What happens to my insurance if I dis-enroll?

Great Lakes PACE will assist you with discharge plans, including referrals to other community health programs and providers.  We also provide help with re-enrollment in Medicare, Medicaid, and Medicare Part D coverage.

Can I see my own doctor after enrollment?

When enrolled in Great Lakes PACE, PACE services take the place of the care and medicine you would usually get through Medicare and /or Medicaid. The providers and contract providers of Great Lakes PACE will be the participant’s sole service provider. Great Lakes PACE guarantees access to services, but not to a specific provider.

Can I appoint someone to help me file a grievance or appeal?

If a participant would like to appoint a person to file a grievance or request an appeal on his or her behalf, the enrollee and the person accepting the appointment must fill out this form (or a written equivalent) and submit it with the request.

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms1696.pdf

What is a grievance and how do I file a grievance?

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 Great Lakes PACE staff member at any time.  Grievances can be filed in person, fax, mail, or telephone. For status and process questions regarding a filed grievance, please contact our Center Manager at (989) 272-7610.

 Attn: Center Manager

Great Lakes PACE                                           

3378 Fashion Square Blvd                            

Saginaw, MI 48603

 

Fax: (989) 272-7669

After Hours: (989) 272-7610

 

What is an appeal and how do I file?

 If Great Lakes PACE refuses to provide or pay for a service that you feel is necessary for your health, you or your representative have the right to request an appeal of the Great Lakes PACE’s decision. If your Care Team denies a request for services or payment or reduces your services, your team will provide you written information about the denial and about how to file an appeal.  There are two types of appeals; internally and externally through Medicare and/or Medicaid appeals process.

Internal appeals are received either verbally or in writing to Great Lakes PACE.  An appeal must be submitted within 90 days of the day that Great Lakes PACE notifies you that your request for services has been discontinued, reduced, or denied.  Until you receive notice of final decision, you may choose to continue to receive any service in question, but 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 same the time of filing through Great Lakes PACE. You have the right to request an expedited appeal.

 

Can I file an appeal externally?

You can file an external appeal to either Medicare or Medicaid, but not both. Great Lakes PACE staff will assist you, at your request, with an external appeal. 

Medicaid appeal-

Michigan Administrative Hearing System

PO Box 30763

Lansing, MI 48909

 

(877) 833-0870

 

Medicare-

If you would like to file a Medicare appeal, you must go through the Great Lakes PACE appeal process before it would go to an outside appeals organization.  Great Lakes PACE will assist you with filing an appeal with Medicare