Expedited External Review

State process

If you have filed a request for an expedited internal grievance, you may request an expedited external review from the Michigan Commissioner of Financial and Insurance Services.

You may file a request for an expedited external review only when you think that we have wrongfully denied, terminated or reduced coverage for a health care service prior to your having received that health care service.

The expedited external review process is as follows:

Within 10 days of your receipt of our denial, termination or reduction in coverage for a health care service, you or your authorized representative may request an expedited external review from the commissioner by calling 1-877-999-6442 to request the forms required.

Mail your request, including the required forms that we will give you, to:

Michigan Division of Insurance
Benefit Inquiry Section
P.O. Box 30220
Lansing, MI 48909

Immediately after receiving your request, the commissioner will decide if it is appropriate for external review and assign an independent review organization to conduct the expedited external review. If the independent review organization decides that you do not have to first complete the expedited internal grievance procedure, it will review your request and recommend within 36 hours whether the commissioner should uphold or reverse our determination.

The commissioner must decide within 24 hours whether or not to accept the recommendation and will notify you. The commissioner's decision is the final administrative remedy under the Patient's Right to Independent Review Act of 2000.



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