If you don't agree with the final decision, you may appeal in writing to the Department of Insurance and Financial Services no later than 60 days following your receipt of our final determination at:
Department of Insurance and Financial Services
Office of General Counsel - Appeals Section
P.O. Box 30220
Lansing, MI 48909-7720
When filing a request for an external review, you will be required to authorize the release of any applicable medical records to the state that were used for review in reaching a decision.
If we fail to provide you with our final determination within 30 calendar days for preservice claims or 35 calendar days for postservice claims (plus 10 additional business days if we request additional medical information) from the date we receive your written grievance, you may request an external review from the Department of Insurance and Financial Services. You must do so within 60 business days of the date you either received our final determination or the date our final determination was due. Mail your request for a standard external review, including the required forms that we will provide to you, to the Department of Insurance and Financial Services at the address noted above.
If you are a member of an ERISA*-qualified group, you may file a lawsuit according to the time limits defined in your General Provisions and Benefits booklet after completing our internal grievance process. You do not need to file an appeal with the Department of Insurance and Financial Services. Non-ERISA groups or nongroup subscribers, including their dependents, must exhaust all grievance steps (including an external review by the Department of Insurance and Financial Services) prior to filing a civil action. Subscribers may obtain further information from the local U.S. Department of Labor Office or by contacting the State of Michigan insurance commissioner. If you do not know if your group is an ERISA-qualified group, you should contact your employer.
*Employee Retirement Income Securities