Coronavirus Health Insurance Appeals To Be Prioritized: State

MICHIGAN — Health insurance claims related to the denial of coverage for testing or treatment of the new coronavirus will be prioritized over others, the state announced Wednesday.

“All consumers have the right to an independent external review if their health insurance claim is denied,” said Anita Fox, Director of The Michigan Department of Insurance and Financial Services (DIFS). “Those claims with urgent health needs with COVID-19 treatment denials, are being given priority.”

When consumers contact DIFS regarding a health insurance claim denial, the department will review the claim to determine if there is eligibility for review under the Patient's Right to Independent Review Act (PRIRA). If the claim involves issues of medical necessity, the department will work with an independent review organization to evaluate whether the denial was appropriate.

Consumers can file a request for external review by visiting the DIFS website. Consumers with questions about the PRIRA process should contact DIFS at (877) 999-6442.

“Consumers with questions about a health insurance denial, loss of health coverage due to job loss, or other health insurance concerns, should contact DIFS,” Fox said. “The DIFS’ call center and analysts are available from 8 a.m. to 5 p.m., Monday through Friday, to assist Michiganders with their non-Medicaid health insurance questions.”

DIFS can also help consumers with other health insurance questions and complaints. The Michigan Health Insurance Consumer Assistance Program (HICAP) can provide shopping tips and help answer questions about health insurance, including Special Enrollment Periods for those experiencing job loss or an income reduction.