You are entitled by law to request an external review from an independent third party, which means your insurer no longer has the final say over whether to approve a treatment or pay a claim. Under Michigan law, you are entitled to an external review if:

  • Your insurer denies, reduces, or terminates your coverage; and
  • You have completed the internal grievance process or your insurer does not provide you with a decision within the allotted time.[5]

You may also request an expedited external review if your medical situation is urgent and waiting 35 days would jeopardize your life or ability to function. You may request an expedited external review while you request an expedited internal grievance.[6]