Priority Health Choice, Inc., appeal process (Medicaid and Healthy Michigan Plan)
If you have called our Priority Health Choice, Inc., Customer Service representatives at the number on your Priority Health membership card and you're not satsified with the answers provided to you, you can formally request that Priority Health change the response or decision provided. You or someone on your behalf can appeal our decision.
There are two steps to the Priority Health Choice appeal process. If your issue is resolved at Step 1, you don't have to do anything else. If you complete Step 1 and are still not happy with our decision, you may choose to go to Step 2.
Filing a formal Level 1 appeal
Filing a formal Level 2 appeal
First, read the appeals process online:
When to file an appeal with Priority Health Choice, Inc.
- You must file an appeal request within 60 days from the date you learn of the decision you do not agree with.
- You must file a request for a state external review with DIFS or a Fair Hearing within 127 days of the Priority Health Choice denial of our appeal.
Second, you can file an appeal in one of several ways:
Whichever way you choose, we suggest you look at the Priority Health Choice instructions first. Then you can:
Submit your appeal online by filling out our online appeal form.
OR, fill out a paper form. You can print the form now or call Customer Service at the number listed on the back of your membership card and ask us to mail one to you. It includes instructions on how to mail or fax back to us.
OR, call us at the number on the back of your membership card and we'll take down your information for you and help you get started.
What happens next
Priority Health Choice, Inc. has 30 days from the date we receive your appeal to make a decision about your request and send the decision to you in writing or in speaking with you.
Request a state external review or fair hearing
If you are not satisfied with the resolution of your problem or complaint after completing the Priority Health Choice, Inc., appeal process, you may request a review by the Michigan Department of Insurance and Financial Services (DIFS) within 120 days or a Fair Hearing within 90 days from the date you receive the appeal decision from Priority Health.
Check the Priority Health Choice, Inc. Appeal Process document for information on how to file a request with the state.