Expedited Internal Grievance
If a physician substantiates (either orally or in writing) that adhering to the timeframe for the standard internal grievance process would seriously jeopardize your life or health, or would jeopardize your ability to regain maximum function, you may file a request for an expedited internal grievance.
You may file a request for an expedited internal grievance 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, or if you believe we have failed to respond in a timely manner to a request for benefits or payment.
The procedure is as follows:
You may submit your expedited internal grievance request by telephone to 313-225-6800. The required physician's substantiation that your condition qualifies for an expedited grievance can also be submitted by telephone.
We must provide you with our decision within 72 hours of receiving both your grievance and the physician's substantiation.
If you do not agree with our decision, you may, within 10 days of receiving it, request an expedited external review from the Michigan Commissioner of Financial and Insurance Regulation.
You should also know
You may authorize another person, including your physician, to act on your behalf at any stage in the expedited internal grievance process. Your authorization needs to be in writing.