How to appeal a health insurance denial in Michigan
The short answer
Start with your plan’s own appeal. If the plan says no again, you can usually ask an independent reviewer to decide. Michigan lets you ask an independent reviewer to decide, through Michigan Department of Insurance and Financial Services. The deadline to ask: within 127 days of the final decision.
Does this apply to you? State external review covers plans regulated by Michigan: individual and Marketplace plans, and job-based plans your employer bought from an insurer. Many large employers are self-funded; their plans follow the federal external review process, and state law usually does not apply (29 CFR 2590.715-2719(c)(1)). Medicare, Medicaid, TRICARE and federal employee plans have their own appeals: see the plan guides.
External review in Michigan
Within 127 days of the final decision
DIFS completes expedited external appeals within 72 hours. You must have requested an expedited appeal with the plan, DIFS must receive the request within 10 days of the plan's decision, and a letter from your treating physician is required; pre-service denials only.
Free
State-regulated plans (insurance bought in Michigan or through an employer that buys insurance). Self-funded employer plans use the federal process.
File with DIFS under PRIRA using the online form or paper form FIS 0018 (email DIFS-HealthAppeal@michigan.gov, fax 517-284-8838, or mail). DIFS decides contract disputes itself and sends medical-necessity issues to an independent review organization; the DIFS Director issues an order. Ineligible: non-governmental self-funded plans, Medicare supplement, disability income, hospital indemnity, long-term care and similar policies.
Who to contact
Before external review: the internal appeal
External review usually comes after your plan’s own appeal. The deadline for that first appeal depends on the type of plan:
- Employer plan: 180 days from the day you receive the denial notice
- Marketplace plan: 180 days from the day you receive the denial notice
- Medicare Advantage: 60 days from when you receive the denial (counted as 65 days from the notice date)
- Medicare Part D: 60 days from when you receive the denial (counted as 65 days from the notice date)
- Original Medicare: 120 days from when you receive the notice (counted as 125 days from the notice date)
- Medicaid: 60 days from the date printed on the denial notice
- FEHB (federal employees): 6 months from the date of the denial notice
- TRICARE: Mail within 90 days after the date of the denial notice
Questions people ask
How long do I have to ask for an external review in Michigan?
Within 127 days of the final decision
Can I get a fast external review in Michigan?
DIFS completes expedited external appeals within 72 hours. You must have requested an expedited appeal with the plan, DIFS must receive the request within 10 days of the plan's decision, and a letter from your treating physician is required; pre-service denials only.
Does external review cost anything in Michigan?
Free
Do Michigan’s rules apply to my job-based plan?
Only if the plan is fully insured, meaning your employer bought a policy from an insurance company. Self-funded employer plans generally follow the federal external review process instead. Your Summary Plan Description or HR benefits team can tell you which kind you have.
Sources
- DIFS: Appealing a Decision Made by Your Health Insurer
The appeal must be submitted within 127 days of the final decision.
- DIFS press release (June 29, 2026)
The PRIRA process is free and simple
This page is general information about appeal rules in the United States. It is not legal or medical advice. Rules can change, and your plan’s documents and your denial letter control the dates that apply to you.