More Michiganders Are Appealing Denied Health Insurance Claims with Help through DIFS’ Free Process – Here’s How

DIFS launches a public awareness campaign to explain how Michiganders can use the Patient's Right to Independent Review Act

Media Contact: [email protected] Consumer Hotline: 877-999-6442, Michigan.gov/DIFScomplaints

FOR IMMEDIATE RELEASE: November 5, 2025

(LANSING, MICH) - The Michigan Department of Insurance and Financial Services (DIFS) announced that more Michiganders are appealing health insurance claim denials under the Patient's Right to Independent Review Act (PRIRA).

"When a health insurance company says 'no' to a treatment their doctor says is necessary, consumers should know that that does not have to be the final word," said DIFS Director Anita Fox. "Michiganders have the right to an impartial, expert review of final health insurance claim denials to ensure they obtain the health care services to which they are entitled. You can reach DIFS by calling 877-999-6442, Monday through Friday from 8 a.m. to 5 p.m., or by visiting Michigan.gov/HealthInsuranceAppeal."

In 2024, DIFS saw a 22% increase in PRIRA appeals compared to the previous year, showing that more residents are utilizing this important protection.

In an effort to help keep Michiganders informed about their rights to a free health insurance appeal, DIFS is launching a public awareness campaign to let Michiganders know that if their health insurance claim has been denied, they have the right to a free appeal. Michiganders are encouraged to visit Michigan.gov/HealthInsuranceAppeal for more information and resources.

How to Appeal a Health Insurance Claim Denial:

When a health insurance company declines to cover a service, it issues an "adverse determination." If this happens, consumers have the right to:

1. File an appeal with their health insurance company. The company must respond within 30 days for care not yet received or within 60 days for care already provided.
2. Request an external review through DIFS if they disagree with the health insurance company's final decision or do not receive a timely response. If an independent medical expert agrees the treatment is medically necessary, the health insurance company must cover it.
3. Visit Michigan.gov/HealthInsuranceAppeal to complete the online request form. If waiting for a standard review could seriously jeopardize a consumer's health or recovery, they may request an expedited review for a faster decision.

How to Request an External Review:

The PRIRA process is free and simple:

• Call DIFS at 877-999-6442. Representatives are available Monday through Friday from 8 a.m. to 5 p.m. to answer questions and guide consumers through the process.

With more Michiganders taking action through PRIRA, DIFS remains focused on educating consumers and ensuring fair access to medically necessary care to which they are entitled. For more information, visit Michigan.gov/HealthInsurance or call 877-999-6442.

The mission of the Michigan Department of Insurance and Financial Services is to ensure access to safe and secure insurance and financial services fundamental for the opportunity, security, and success of Michigan residents, while fostering economic growth and sustainability in both industries. In addition, the Department provides consumer protection, outreach, and financial literacy and education services to Michigan residents. For more information, visit Michigan.gov/DIFS or follow the Department on Facebook, X, or LinkedIn.

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