Requesting a coverage decision for a medical service
There are three ways you can request a coverage decision for a medical service or to go to a doctor or hospital outside the Priority Health Medicare network.
This is for medical services only. If you want to request an exception for Part D prescription drugs or Part B medical drugs, learn more.
Requesting a decision within 14 days
Unless there are medical reasons for us to respond more quickly, we'll generally make a decision in no more than 14 days after your request for a medical coverage decision.
Write to us at:
Health Management Department, MS-1255
Priority Health Medicare
1231 East Beltline Ave. NE
Grand Rapids, MI 49525
Fax us at 888.647.6152
To help us better process your request, please include your full name, date of birth, address, contract number, and a brief description of your request.
Requesting a decision within 72 hours
You can request an expedited (fast) exception if you or your doctor believe that your health could be seriously harmed by waiting up to 14 days for a decision. You can request an expedited decision by calling customer service at 888.389.6648 (TTY call 711).
Filing an appeal if you're not happy with our decision
If you aren't satisfied with the coverage decision we make, you can ask us to reconsider. This is called "filing an appeal." Learn more.