MyPriority plan appeal process

Note: This process applies only if you’re a member of a MyPriority individual health plan. Choose the Priority Health plan you have from the menu on the right to see the process that applies to you.

If you have called our MyPriority® Customer Service representatives and you are still not satisfied 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 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.

Level 1

Filing an appeal with Priority Health

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Request a state external review through DIFS

First, read the appeals process online:

When to file an appeal with Priority Health

  • You must file an appeal within 180 days of receiving an "adverse determination" of your initial request.
  • You must file a request for a state external review within 127 days Priority Health denied your appeal.

Appeal process timeline

If you have not yet received the services:

We must make a final determination within 30 calendar days after we receive your appeal to:

  • Let you know our decision
  • Or, let you know that we need more information before we make a decision

The 30-day count does not include any days you or your representative may delay the process.

If you have already received the services:

We must make a final determination within 60 calendar days after we receive your appeal to:

  • Pay the claim
  • Or, write to you explaining our decision
  • Or, let you know that we need more information before a decision is

The 60-day count does not include any days you or your representative may delay the process.

Second, send us your appeal in ONE of these four ways:

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Submit your appeal online by filling out our online appeal form.

Online appeal form

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OR, fill out a paper form. You can print the form and instructions now or call Customer Service and ask us to mail one to you.

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OR, type up your request and fax it, along with any additional documentation you would like to include in your case review, to us at 616.975.8894, or email it to the appeals team

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OR, call us at the number on the back of your membership card and request a verbal appeal. We'll take down your information and help you get started.

Step 2: Request a state external review

If you are not satisfied with the resolution of your problem or complaint after completing the Priority Health Appeal Process, you have 120 days after receiving your Step 1 decision to request a review by the Michigan Department of Insurance and Financial Services (DIFS).

Check the instructions in the MyPriority appeal process PDF for how to file a request with the state.

More details

You'll find more details in the coverage documents you received when you enrolled in your MyPriority plan. These documents may include an Agreement or an Insurance Policy. Call Customer Service with questions.