Michigan Department of Insurance and Financial Services Reminds Consumers of Their Right to Appeal Denied Health Insurance Claims

Media Contact: [email protected]
Consumer Hotline: 833-ASK-DIFS, [email protected]

FOR IMMEDIATE RELEASE: June 29, 2026

(LANSING, MICH) To celebrate National Insurance Awareness Day on June 28, the Michigan Department of Insurance and Financial Services (DIFS) is reminding Michiganders that if they have had a health insurance claim or prior authorization request denied, they have the right to appeal under the Patient's Right to Independent Review (PRIRA).

"Policyholders faced with a health insurance company's denial of a claim for treatment their doctor says is necessary have the right to a free appeal that includes an impartial, expert review to ensure that patients are covered for the health care services to which they are entitled," said DIFS Director Anita Fox. "Since 2020, more than twice as many Michiganders have had their clam denials reviewed under PRIRA, and all Michiganders should be aware of their right to this free appeal. DIFS staff is here to assist Michiganders through the PRIRA process, Monday through Friday from 8 a.m. to 5 p.m. at 877-999-6442, or you can visit Michigan.gov/HealthInsuranceAppeal to start the appeal process."

If you disagree with your insurer's decision, there is a three-step process to appeal the denial.

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.

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. Translation services are available for individuals with limited English proficiency who contact the Department. For more information, visit Michigan.gov/DIFS or follow the Department on Facebook, X, or LinkedIn.

####