Request a coverage decision

To request a coverage decision for a medical service that does not involve prescription drugs or to go to a doctor or hospital outside the Priority Health Medicare network:

Call Customer Service at 888.389.6648 (TTY call 711)

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 your request.

When you'll hear from us

Unless there are medical reasons for us to respond more quickly, we’ll generally make a decision within 72 hours of your request for a coverage determination or exception.

Expedited decisions

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 and/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 good for the remainder 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 or your prescriber can ask us to reconsider. This is called "filing an appeal." Learn how.