Coverage varies depending on plan
Applies to:
Group HMO, EPO, POS and PPO plans
Individual MyPriority® HMO, POS and PPO plans
Medicare Advantage plans
ECT authorizations
Outpatient ECT authorization
In-network providers
- Not required when performed by a participating physician at an in-network facility
Out-of-network providers
- Required when performed by a non-participating physician or at an out-of-network facility. If you're a provider located within the state of Michigan and would like to join our provider network, visit our credentialing application page. Out-of-network providers request mental health and substance use disorder services using our Behavioral Health authorization form.
Inpatient ECT authorization
Inpatient ECT requests are reviewed in conjunction with review of the inpatient admission. Please attach the request to the Inpatient Authorization in GuidingCare, or if you're a non-participating provider, please fill out our Behavioral Health authorization form, attach necessary clinical information and fax to our Behavioral Health department at 616.975.0249.
ECT medical necessity criteria
The term "medical necessity" is used to mean care that is determined to be effective, appropriate and necessary to treat a given patient's disorder. To determine medical necessity for ECT, the Priority Health Behavioral Health department relies on InterQual® Behavioral Health criteria.