Inquiry and Grievance Procedures

We hope that you are always happy with the service you receive from us. We know, however, that from time to time you may have a problem or concern that you want us to address.

If you have a question, concern or complaint about Priority Health, please call our Customer Service Department at 1 888-975-8102 or 616 464-8102. Our Customer Service Department will try to resolve your problem as soon as possible.

If you have a complaint or problem that our Customer Service Department cannot resolve informally or you are unhappy with our resolution, you may initiate formal grievance proceedings. For a complete copy of our Grievance Procedure, please contact our Customer Service Department. Here is a summary of the steps you can take.

Step 1: Tell Customer Service that you want to file a formal grievance. Our Grievance Committee will look at your complaint and make a decision. They will send the decision to you in writing.

Step 2: If you are not happy with this decision, you can send your complaint to our Appeal Committee. They will review the complaint. They will also send you their decision in writing.

Step 3: If you are not happy with the decision from the Appeal Committee, you can have your complaint reviewed by the Office of Financial and Insurance Services in Lansing, Michigan. You may request this review by filling out the External Review form that will be included with the decision from the Appeal Committee. You may also send your complaint to the following address:

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

                            1 877 999-6442
                            www.michigan.gov/cis

Expedited Grievance Procedure
If your doctor tells us that the time it takes to resolve your complaint may put your life in danger, we will follow our emergency timeline.

Obtaining Information about the Grievance Procedure
To obtain a complete copy of our Grievance Procedure and Grievance Filing Form, or to find out more about your appeal rights, please contact our Customer Service Department.

Administrative (Fair) Hearing
We hope that you will give us a chance to respond to your concerns by following this process. You do not have to follow this process. You can ask the State of Michigan to review the problem at any time. This is called an Administrative or Fair Hearing. To ask for a hearing call the Customer Service Department at 1 888-975-8102 and ask to have an Administrative Hearing form sent to you. You may also call the State of Michigan Recipient Hotline to request the form. Their number is 1 800-642-3195.

Following are the steps for the State's Administrative (Fair) Hearing process:

Step 1: Fill out the request (hearing form) and return it to the address listed on the form.

Step 2: A worker from the State will get in touch with you about your complaint and try to fix your problem before a hearing is scheduled. A hearing will be scheduled if they cannot fix the problem.

Step 3: You will be sent a letter telling you when and where your hearing will be held.

Step 4: The results will be mailed to you after the hearing. If your complaint is taken care of before your hearing date, you must call to ask for a hearing request withdrawal form. You can call 1 800 642-3195 to ask for this form.

Filing a Lawsuit against Priority Health
Before filing a lawsuit against us, you must complete our Grievance Procedure as described in this Section 12. In addition, you must file suit no later than two years after the date of service or receiving notice that Coverage for the requested service is denied.