What is prior authorization?
Prior authorization (PA)—also called preauthorization—means the health plan must approve certain care before it will cover it. Doctors or hospitals often submit PA for you, but you still have rights if PA is denied.
A PA denial is different from a bill denial after care already happened. With PA, the fight is usually about whether the plan will allow the treatment at all.
Overview for any state: Prior authorizations. This page is Michigan-only.
Confirm plan type: Michigan: Start Here.
Michigan PA rules
Michigan's comprehensive PA reforms are in MCL 500.2212e (Public Act 60 of 2022, operational June 1, 2023). The statute generally does not apply to traditional Medicaid.
Standard (non-urgent) prior authorization
- Decision within 7 calendar days of submission (or within 7 days after additional information is submitted)
- If the insurer does not grant, deny, or request more information in time, the request is deemed granted (§2212e(10))
- Electronic PA through a web portal required; fax-only paper systems are not sufficient except for temporary tech failures
Urgent prior authorization
- Provider-certified urgent requests: decision within 72 hours, or deemed granted if late (§2212e(11))
- Same 72-hour rule after the insurer requests additional information
Denials and PA appeals
- Denial notice must include reasons, evidence-based criteria, appeal rights, and how to submit documentation ( §2212e(7))
- PA appeal reviewed by a specialty-matched physician when possible (§2212e(8)–(9))
- Approved PA remains valid at least 60 calendar days or longer if clinically appropriate (§2212e(12))
Transparency
Insurers must post PA requirements and clinical criteria online and report annual PA denial statistics to DIFS ( §2212e(13)–(14)).
Where to look up PA rules
Each carrier posts PA lists and criteria on its provider portal. Use the links on Michigan: prior auth & internal appeals links or call the number on the member ID card.
Marketplace plans: Blue Cross Blue Shield of Michigan, Priority Health, Ambetter, Molina, Oscar, and others through HealthCare.gov.
Medicaid / Healthy Michigan
Medicaid managed care uses separate authorization and appeal rules—not MCL 500.2212e. See MDHHS — Medicaid hearings and Michigan internal appeals.
If PA is denied
Appeal the adverse determinationthrough the carrier's internal grievance process, then PRIRA external review with DIFS if needed.
Next: Michigan internal appeals → Michigan external review (DIFS).
Urgent care
Have the provider certify the request as urgent under §2212e. For appeal delays that threaten life, health, or maximum function, request expedited internal and external review (MCL 550.1907, MCL 550.1913).