You should submit your request for external review to the Michigan Department of Insurance and Financial Services (“Department”) within 60 days from the date that your insurer sent you the final decision. If you are requesting an expedited external review, you must submit your request within ten days of receipt of the most recent decision letter.[7]

Information. You can find a copy of the external review request form here. Your request should include the following information:

  • The name, address, telephone number, and relationship to patient of the person filing the request;
  • The patient’s name;
  • The name of the insured person;
  • The name of your health insurer;
  • The policy number, group number, and claim number, if applicable;
  • Dates service was received or requested;
  • The name of the physician and medical facility involved;
  • A description of the problem involved.[8]

Supporting document. You should also include the following supporting documents with your request:

  • A copy of the final adverse determination letter;
  • Copies of bills, explanations of benefits, and medical records related to the request;
  • Copies of correspondence between you and the health insurer;
  • Statements from doctors; and
  • Any research material that supports your position.[9]

Where to submit for a standard external review. You can submit the request and supporting documents by fax to (517) 284-8838, by email to [email protected], or by mail to:[10]

DIFS-Office of General Counsel-Appeals Section
P.O. Box 30220
Lansing, MI 48909-7720

Where to submit for an expedited external review. If you are requesting an expedited external review, you should submit your request and supporting documents by courier or delivery to the following address:

DIFS-Office of General Counsel-Appeals Section
530 W. Allegan Street, 7th Floor
Lansing, MI 48933[11]

If you have any questions, you can call the Department at (877) 999-6442.

If your case involves a decision regarding provisions of your insurance contract or policy, the review will be conducted by the Director of the Department. If your case involves a question of medical necessity, it will be referred to an independent review organization for review.[12]