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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.

Step 1: Filing an appeal with Priority Health

Step 2: Requesting a state external review through DIFS the next business day

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:

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

Online appeal form

Fill out a paper form:

OR call Customer Service and ask us to mail one to you.

Type up your request without using the form and fax it, with documentation, to us at 616.975.8894, or email it to the appeals team.
Call the number on the back of your membership card and one of our Customer Service representatives will complete a verbal grievance/appeal on your behalf.

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.