Grievance Procedure

If you wish to proceed with the formalized Midwestern Dental Grievance Procedure please forward your issue in writing to:

Midwestern Dental Plans
5050 Schaefer Road
Dearborn, MI 48126

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 the following address. The manager will investigate and respond in writing within five days. If there is an adverse determination, you may appeal to Step Two. 

Patient Services Manager, Midwestern Dental Plans
5050 Schaefer Road
Dearborn, MI 48126

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:

Office of Financial & Insurance Division, Health Plan Division
611 West Ottawa, Second Floor
P. O. Box 30220
Lansing, MI 48909-7720

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