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:
Write to us at:
Health Management Department, MS-1255
Priority Health Medicare
1231 East Beltline Ave. NE
Grand Rapids, MI 49525
Fax us at 888.647.6152
To help us better process your request, please include your full name, date of birth, address, contract number, and a brief description of the service being requested.
When you'll hear from us
Unless there are medical reasons for us to respond more quickly, we'll generally make a decision within 14 days of your request for a medical coverage decision.
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 Part D prescription drug or Part B medical drug coverage decisions
If our coverage decision 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.
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." Learn how.