MyPriority plan appeal process
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.
Filing an appeal with Priority Health
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
Second, send us your appeal in ONE of these four ways:
Submit your appeal online by filling out our online appeal form.
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.
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
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.
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.