Clarification: Southeast Michigan Partners and the Southeast Michigan Network are different networks
We’ve heard about some confusion between our Southeast Michigan Partners tiered network and our new narrow network, the Southeast Michigan Network. We want to clarify that these are two different networks attached to different plans. They do not share the same providers, and they are not available to members in all the same counties.
What is Southeast Michigan Partners?
Southeast Michigan Partners is one of our tiered networks. It is available to employer groups through multiple plans in six counties:
- Livingston
- Macomb
- Oakland
- St. Clair
- Washtenaw
- Wayne
It includes multiple health systems in its first tier:
- Ascension
- Corewell Health - East
- Detroit Medical Center
- Lake Huron Medical Center
- Michigan Medicine
- Trinity Health
Members will benefit from lower coinsurance, copays and deductibles when receiving care through a Tier 1 provider. Members still have access to the entire Priority Health network, but care received from Tier 2 providers requires greater member cost-sharing.
What is the Southeast Michigan Network?
The Southeast Michigan Network is one of our narrow networks. It’s a MyPrioritySM HMO narrow network plan available to individuals under 65 and their families in three counties:
- Macomb
- Oakland
- Wayne
It includes two health systems:
- Corewell Health - East
- Trinity Health
Members are only covered when receiving care from in-network providers, except in emergencies.
How can you tell which network a Priority Health member is part of?
If you’re confused about whether a patient is covered on the Southeast Michigan Partners tiered network or the Southeast Michigan narrow network, check one of two places:
- The patient’s Priority Health member ID card. Note the different details listed in the Health plan field on each card.
- Member Inquiry in prism. In a member’s plan information, check the “product type” listed. For members on a Southeast Michigan narrow network plan, it will say “Southeast Michigan Network.” For members on the Southeast Michigan Partners tiered network, it will say “SEMP Tiered Network,” as in the screenshot below.
How can you find in-network providers for a member?
Once you know the kind of plan your patient has, you can use our Find a Doctor tool to find in-network providers.
- Search by plan type by clicking the yellow button in the upper right corner.
- Click the “Find a different plan” button.
- Search “Southeast Michigan Network” for the narrow network of the same name or “Southeast MI Partners” for the tiered network of the same name. Note that there are two options for “Southeast MI Partners.” Choose option A for HMO plans or POS A plans, and option B for PPO, EPO or POS B plans. (If you’re not sure whether a plan is POS A or POS B, the “Health plan” field of the member ID card will indicate either “PriorityPOS-A Southeast MI Partners” or “PriorityPOS-B Southeast MI Partners.”)
- You'll then see only in-network providers when you search. If a provider you search for is Tier 2 for a member in a tiered-network plan, the provider’s information box will tell you.
You can also search for providers in Find a Doctor without having a plan selected.
- Search for and then click the provider you want.
- Click the link in their information box under the “plans accepted” heading to bring up a list of the types of plans they accept.
- The Southeast Michigan Network will be listed under “Individual and Family Plans” if it is an accepted plan type, and “Southeast MI Partners” will be listed under “Employer Group Plans.”
What should you do to make sure members receive in-network care whenever possible?
Be sure to check member eligibility before seeing them using their member ID card or prism, or both. When referring them, use Find a Doctor to find a provider in-network for them according to their plan type. Taking these steps will help members avoid unnecessary out-of-pocket costs.