Request a coverage decision

To request a coverage decision for a medical service or to go to a doctor or hospital outside the Priority Health Medicare network:

Call Customer Service.

Or write to us at:

Health Management Department, MS-1255
Priority Health Medicare
1231 East Beltline Ave. NE
Grand Rapids, MI 49525

Requesting a decision within 24 hours

You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 72 hours for a decision. Look for "Expedited decisions" on page 2 of the form and check the box to let us know.

When you'll hear from us

Unless there are medical reasons for us to respond more quickly, we'll generally make a decision within 72 hours of your request for a prescription drug coverage decision.

Expedited decisions

If your request to expedite is granted, after we get a supporting statement from your doctor or other prescriber we must give you a decision within 24 hours for prescription drug coverage decisions.

If our exception is in your favor, we must authorize the drug we agreed to provide. For prescription drug exceptions our approval is usually good for the rest of the calendar year.

If our coverage decision is in your favor

We must authorize the drug or medical service we agreed to provide. For prescription drug exceptions our approval is usually good for the rest of the calendar year.

Filing an appeal if you are not happy with our decision

If you aren't satisfied with the coverage decision we make, you can ask us to reconsider. This is called "filing an appeal."

Go to instructions for filing an appeal.