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Mich. Comp. Laws Ann. § 550.1907 - Right to request external review for adverse determination; written notice

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A health insurer must give an individual written notice and an explanation of internal grievance and external review processes whenever the insurer decides to deny, reduce, or terminate an individual’s health care services. The notice must explain that an individual must exhaust the internal grievance processes before pursuing external review unless pursuing an expedited internal grievance would place the individual’s health or life at risk or the health carrier has not responded within the appropriate time frame and the individual has not authorized the delay. The notice must include a copy of the insurer’s “standard and expedited review procedures” and must highlight the provisions that allow an individual to provide additional information during the review process. Finally, the insurer must include, alongside the copy of the review procedures, a form that will allow an individual to authorize “the health carrier and health care provider to disclose protected health information, including medical records, concerning the [individual] that are pertinent to the external review.”

Current as of June 2015