Health insurance or Medicaid said no in Michigan? Deadlines and free help

In Michigan, your health plan is regulated by Michigan Department of Insurance and Financial Services (DIFS), if it is a state-regulated plan.

Michigan runs its own independent review of denials: External review under the Patient's Right to Independent Review Act (PRIRA). You generally have 120 days to ask for it.

External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.

Pick your plan type

Which kind of coverage was denied? The plan type decides which rules and deadlines apply.

Insurance I bought or got through work

Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.

My employer pays claims itself (self-funded)

Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.

Michigan Medicaid

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (HealthCare.gov) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decisionWrite my appealFree help

Checked against official sources: October 30, 2026.

Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.

How long do I have in Michigan?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
120 days
Hearing deadline
90 days
Appeal to the plan first
60 days (federal rule)
Appeal deadline – HealthCare.gov
90 days (federal rule)

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

DIFS does not conduct external reviews for non-governmental self-funded health plans, Medicare or Medicare Supplement, workers' compensation, auto insurance, or federal employee and military benefit programs. If your employer plan is self-funded, ask your employer or the U.S. Department of Labor (EBSA).

Step 1: Appeal to your plan in Michigan

What it is called: Internal grievance (internal appeal)

Your insurer must give its final decision within 30 calendar days for care you have not received yet, and within 60 calendar days for care you already received. The internal process can involve 2 or 3 reviews. If the insurer does not decide on time without your agreement to a delay, you can go straight to external review.

Law: MCL 550.1907(3)(a)

All the details →

Step 2: Outside review in Michigan

External review under the Patient's Right to Independent Review Act (PRIRA)

Deadline to ask: 120 days.

All the details →

Urgent care in Michigan: faster decisions

Outside review

If waiting for a standard review could seriously jeopardize your life, health or ability to regain maximum function, you can ask for an expedited external review. You must have asked your plan for an expedited appeal, DIFS must receive your request within 10 days, and you must attach a letter from your treating doctor explaining why it is urgent. It is only for care you have not received yet. DIFS completes it within 72 hours.

Law: MCL 550.1907, 550.1911, 550.1913, 550.1915 (Patient's Right to Independent Review Act, 2000 PA 251)

Urgent: 72 hours

Medicaid

In unusual circumstances an expedited hearing can be requested; write "Expedited Hearing" at the top of the hearing request.

Law: 42 CFR 431.200 et seq

Complaints about your plan in Michigan

For other problems with an insurer or HMO, you can file a complaint with DIFS online or call 1-877-999-6442, Monday through Friday, 8 a.m. to 5 p.m.

www.michigan.gov

Medicaid (Michigan Medicaid (including the Healthy Michigan Plan and MIChild)) denials in Michigan

Who holds the hearing: Michigan Office of Administrative Hearings and Rules (MOAHR), Benefit Services Division, for MDHHS.

Hearing deadline: 90 days

All the details →

Marketplace decisions in Michigan

Michigan uses HealthCare.gov. Appeals go to the federal Marketplace Appeals Center.

HealthCare.gov

1-855-231-1751

Other rights in Michigan

Prior approval deadlines and who can deny

If your provider sends a prior authorization request and the insurer does not approve it, deny it or ask for more information within 7 calendar days (since June 1, 2024), the request is treated as approved. For a request your provider certifies as urgent, the limit is 72 hours. A denial of a non-drug prior authorization must be made by a licensed physician, and an appeal of the denial can only be upheld by a physician in the same or a similar specialty.

Law: MCL 500.2212e(5), (9), (10), (11)

Court review after external review

If you disagree with the DIFS external review decision, you can ask the circuit court for the county where you live, or the Ingham County circuit court, to review it no later than 60 days from the date of the decision.

Law: MCL 550.1915(1)

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in Michigan and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in Michigan

Good to know in Michigan

  • Michigan gives 120 days after you receive the final denial to request an external review from DIFS, but only 10 days for an expedited review.

    Law: MCL 550.1911(1), 550.1913(1)

  • If an insurer misses the 7-day (or 72-hour urgent) prior authorization deadline, the request is treated as granted.

    Law: MCL 500.2212e(10)-(11)

  • Michigan Medicaid members have 90 calendar days from the date of the written notice to ask for a hearing.

Changes in 2024–2026

June 1, 2024: the prior authorization deadline for non-urgent requests dropped from 9 to 7 calendar days, after which an unanswered request is treated as granted.

Law: MCL 500.2212e(10), 2022 PA 60

Questions about appeals in Michigan

How long do I have to appeal a health insurance denial in Michigan?

Your denial notice tells you how long you have to file the internal appeal. Federal rules give at least 180 days for most plans. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.

How do I get an outside (external) review in Michigan?

External review under the Patient's Right to Independent Review Act (PRIRA). File online with the DIFS Health Care Appeals - Request for External Review form, or send the paper form FIS 0018 by email to DIFS-HealthAppeal@michigan.gov, by fax to 517-284-8838, or by mail to DIFS - Office of Appeals, Legal Research, & Market Regulation - Appeals Section, P.O. Box 30220, Lansing, MI 48909-7720 (courier: 530 W. Allegan Street, 7th Floor, Lansing, MI 48933). Include a copy of the final denial, the reasons you are appealing, and supporting documents.

Is outside review free in Michigan?

The external review is free.

How long do I have to ask for a Medicaid fair hearing in Michigan?

90 days. The date of the written notice.

Can I keep my Medicaid benefits while I appeal in Michigan?

If your Medicaid is being reduced, suspended or ended, your benefits continue until the hearing decision if MDHHS receives your hearing request within 10 calendar days of the date of the notice (next workday if the 10th day is a weekend or holiday). For Medicaid, MDHHS policy also keeps your benefits if your request arrives before the date the change takes effect.

Who regulates health insurance in Michigan?

Michigan Department of Insurance and Financial Services (DIFS). DIFS does not conduct external reviews for non-governmental self-funded health plans, Medicare or Medicare Supplement, workers' compensation, auto insurance, or federal employee and military benefit programs. If your employer plan is self-funded, ask your employer or the U.S. Department of Labor (EBSA).

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