Fully funded group plan appeal process

Note: This appeal process applies only if you're a member of a fully funded employer group health plan. Choose the Priority Health plan you have from the menu on the right to see the process that applies to you.

If you have called our 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 three levels to the Priority Health appeal process. If your issue is resolved at one level, you don't need to move to the next level or do anything else.

Level 1

Filing a formal Level 1 appeal

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Filing a formal Level 2 appeal

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Requesting a state external review through DIFS

First, read the appeals process online: 

When to file an appeal with Priority Health

You must file a

  • Level 1 Appeal within 180 days of when Priority Health denied your first request
  • Level 2 Appeal within 90 days of when Priority Health denied your Level 1 Appeal
  • Request for a state external review within 127 days of when Priority Health denied your Level 2 Appeal

How long will the process take?

If we receive your form during non-business hours, we count the day we receive it as the next business day

If you have not yet received the services:

We have 15 calendar days after you make your request to:

  • Let you know our decision
  • Or, let you know that we need more information before we make a decision

If you have already received the services:

We have 30 calendar days from the date we receive your appeal request to:

  • Pay the claim
  • Or, write to you explaining our decision Or, let you know that we need more information before a decision is made

Second, send us your appeal in ONE of these four ways

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

Online appeal form

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Fill out a paper form:

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

icon material file 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.
icon material phone 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.

More details

You’ll find more details in the coverage documents you received when you enrolled in your plan. These documents may include a Certificate of Coverage. Call Customer Service with questions.