Fully funded group plan appeal process
If you have called our 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 three levels to the Priority Health appeal process. If your issue is resolved at one level, you don't need to move to the next level or do anything else.
Filing a formal Level 1 appeal
Filing a formal Level 2 appeal
Requesting a state external review through DIFS
First, read the appeals process online:
When to file an appeal with Priority Health
You must file a
- Level 1 Appeal within 180 days of when Priority Health denied your first request
- Level 2 Appeal within 90 days of when Priority Health denied your Level 1 Appeal
- Request for a state external review within 127 days of when Priority Health denied your Level 2 Appeal
How long will the process take?
If we receive your form during non-business hours, we count the day we receive it as the next business day
Second, send us your appeal in ONE of these four ways
Submit your appeal online by filling out our online appeal form.
Fill out a paper form:
OR call Customer Service and ask us to mail one to you.
You’ll find more details in the coverage documents you received when you enrolled in your plan. These documents may include a Certificate of Coverage. Call Customer Service with questions.