Asking for reimbursement when you pay a claim your plan should pay

Sometimes a provider will ask you to pay in full. Maybe when they check your deductible online, what you've paid hasn't been posted to your electronic record yet, for example.

Ask us to reimburse you for the portion of the claim your plan should pay. Complete a Member Reimbursement Form and attaching proof of payment. A statement that shows only the amount you paid isn't enough, the proof of payment must show:

  • What service(s) you received, including diagnosis and CPT codes
  • Date of service(s)
  • Place of service(s)
  • Amount charged for the service(s)
  • An indicator that the claim was paid in full

Send your request for reimbursement to:

Priority Health Claims Department
P.O. Box 232
Grand Rapids, MI 49501-0232

Send us your request within 60 days of the date you received the services. If you don't ask for reimbursement within 60 days, we can limit or refuse reimbursement. But we will not limit or refuse reimbursement if it is not reasonably possible for you to give us proof of payment in the required time, as long as you give us the required information as soon as reasonably possible.

We will only be liable for a claim or reimbursement request if we receive it within one year after the date of service, unless you didn't submit the claim because you are legally incapacitated.

Questions? Call Customer Service at the number on your member ID card.