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Grievance |
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If you wish to proceed with the formalized Midwestern Grievance Procedure please forward your issue in writing to: Midwestern Dental Plans, Inc., 5050 Schaefer Road, Dearborn, MI. 482126. Step One: If you wish to appeal the denial of a claim for reimbursement or request a review regarding a dental care issue you may do so in writing within two years of receiving an adverse determination by contacting: Patient Services Manager, Midwestern Dental Plans, Inc., 5050 Schaefer Road, Dearborn, MI. 48126. The Manager will investigate and respond in writing within five days. If there is an adverse determination you may appeal to Step Two. Step Two: Should the Plan Member wish to appeal an adverse determination you may do so in writing within sixty days to the Grievance Committee at the address stated in Step One. The Grievance Committee will review your issue within seven days and respond with a determination within two days. If there is an adverse determination you may appeal to Step Three. Step Three: If you wish to appeal that decision you may do so in writing to the Executive Committee within sixty days. The Executive Committee will review the issue within seven days and respond within two days. At this time you may elect to appear or appoint a representative to appear on your behalf before the Executive Board. If there is an adverse determination you may appeal to the Office of Financial & Insurance Division, Health Plan Division, 611 West Ottawa, Second Floor, P. O. Box 30220, Lansing, MI. 48909-7720 This is a brief summary of the process
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