Frequently asked questions

We know health insurance can be confusing. So we’ve answered some of our most frequently asked questions to help members, like you, understand your plan.

Enrollment information

A: It should arrive within 10 business days of becoming a Priority Health member.

A: You may use a copy of your enrollment form as proof of insurance or ask your doctor to look you up in our system. In some cases, you may need to pay for services up front, but we can reimburse you after you’re in our system.

A: Log in to your member account to search hundreds of services within the ‘Am I Covered?’ Tool to see what is included in your specific plan. A schedule of copays and deductibles will be included in your Welcome Packet, along with other details about your plan. You can also find your plan benefits and information and Certificate of Coverage in your online member account.

A: Yes. See the Priority Health Notice of Privacy Practices for details.

Getting care

A: Log in to your member account to search for doctors by name, location, specialty and more through the Find a Doctor tool. You can also call the Customer Service number on the back of your ID card for more assistance.

A: You may select (or change) your PCP in your online member account through the Find a Doctor tool or by calling Customer Service.

A: No. Priority Health does not require you to have a reference. Some specialists do require a referral from your primary care provider, however. Speak to your primary care provider to see if you need a referral to see an in-network specialist.

A: Yes. The kind of coverage you should seek depends on the situation. If you have an emergency or a life-threatening injury, call 911 or go to the emergency room. If you have a problem that is serious but not life threatening (such as a cut, bump, sprain or non-life threatening illness), you’ll save money by going to an urgent care center.

If you have an HMO plan, please contact your primary care provider (PCP) before seeking help. If that isn’t possible, please contact your PCP after your visit for follow-up care.

A: Prior authorization means getting approval in advance to be sure Priority Health will cover certain health care services. If this is the case for you, your provider or specialist will request the authorization on your behalf.

A: You may be able to continue this care for 90 days. To learn more, contact Customer Service or ask your doctor to contact the Provider Helpline at 800.942.4765.

Using your benefits

A: Each health plan is different. Check your plan documents in your member account for details.

A: An Explanation of Benefits (EOB) is a statement from Priority Health about your health care services. It tells you what amount Priority Health paid and how much (if any) of the charges will be billed to you by your provider. The EOB is NOT a bill.

A: Priority Health will cover your children up to age 26. Your child does not need to be a student or live with you to be covered.

A: Please request reimbursement within 60 days of receiving services. If we don’t receive your request within 60 days, we may limit or refuse the reimbursement in some situations. Please provide your information as soon as possible if you know your proof of payment won’t be received in the required time. We will only be liable for a claim or reimbursement request if we receive it within one year of service, unless you didn’t submit the claim because you are legally incapacitated.

A: Coordination of Benefits determines how claims are paid when you’re covered by more than one health care plan. An example could be that you’re also covered by your spouse’s plan or your claim is related to worker’s compensation. If you’re covered by more than one health plan, be sure to inform your employer group or health plan carrier. Any other requests for insurance information should be responded to as soon as possible to help ensure that your claims are processed promptly and paid properly.

A: You can find claim information in your member account. You may also contact Customer Service through the phone number located on the back of your member ID card for more information.

A: The law protects the privacy of our members. That’s why we must have written permission to discuss claim information for dependents ages 18 and older (including your spouse). To receive claim information for others in your family, please send us a signed HIPAA authorization form, found on the Member forms page.

To view your information online log in to your member account or contact Customer Service through the phone number located on the back of your member ID card.