External review in Michigan: deadline, cost and how to ask
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.
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.
Step 2: Outside review in Michigan
- Program
External review under the Patient's Right to Independent Review Act (PRIRA)
- Who runs it
- Michigan Department of Insurance and Financial Services (DIFS), Office of Appeals, Legal Research, and Market Regulation: Insurers, HMOs and nonprofit health care corporations (Blue Cross Blue Shield of Michigan), including insured employer plans
- Deadline to ask
120 days
Michigan law gives you 120 days after you receive the final adverse determination to file with DIFS. For an expedited review, DIFS must receive your request within 10 days after you receive the denial.
- The deadline runs from
The date you receive the insurer's final adverse determination (the decision on your internal appeal)
- Do I have to appeal to my plan first?
You must finish the insurer's internal appeal first, unless the insurer did not decide on time, the insurer waived its internal process, or the insurer did not follow the internal appeal rules. If your doctor says waiting would seriously jeopardize your life, health or ability to regain maximum function, you can file an expedited external review at the same time as an expedited internal appeal.
- How long the review takes
Urgent: 72 hours
- Cost
The external review is free.
- What can be reviewed
Denials based on medical necessity, appropriateness, health care setting, level of care or effectiveness (an 'adverse determination'), and denials of experimental or investigational treatment (your doctor must fill out the DIFS Treating Provider Certification, form FIS 2326). DIFS can also review purely contract questions about covered benefits or coding. The service must reasonably appear to be a covered benefit, and you must have been covered on the date of service. A late answer from the insurer counts as a denial.
- Is the decision final?
The DIFS decision is the final administrative remedy. If the insurer's denial is reversed, the insurer must cover the care. A person who disagrees can ask the circuit court for review within 60 days of the decision.
- How to ask
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. After DIFS accepts your request, you have 7 business days from its notice to send more information.
Law: MCL 550.1907, 550.1911, 550.1913, 550.1915 (Patient's Right to Independent Review Act, 2000 PA 251)
- Forms and online request
- Phone
Write my appeal: free letters
Sources
The official sources for Michigan are listed on the Michigan page.