Patient’s Right to Independent Review Act and ABA Denials
The act, Public Act 251 of 2000, applies to ABA denials by health carriers.
What the act provides
Notice
A carrier must give written notice of internal grievance and external review rights when it sends an adverse determination, and describe them in the policy or certificate.
When to file
After the internal grievance is exhausted, a request is filed with the director within 120 days of receiving the final decision notice. DIFS’s page says 127 days.
Expedited review
Within 10 days of an adverse determination where delay would seriously jeopardize life, health or function.
Outcome
An independent review organization recommends, the director decides, and the decision is the final administrative remedy with judicial review within 60 days.
Back to the ABA guide.
Patient’s Right to Independent Review Act and ABA Denials: short answers
Does it apply to self-funded plans?
It applies to health carriers, so self-funded plans follow ERISA claims procedures.
Is a late response a denial?
The act treats failure to respond in a timely manner as an adverse determination.
Where do I file?
With DIFS.
Patient’s Right to Independent Review Act and ABA Denials: not legal advice. Send us your renewal.
Where these details come from
The laws and rules named on this page link to the official text. This is general information, not legal advice, and rules change, so check the current text.
Patient’s Right to Independent Review Act, Public Act 251 of 2000
MCL 550.1911, request for external review
MCL 550.1913, expedited external review
MCL 550.1915, decision and judicial review
MCL 550.1925, grievance and review descriptions in coverage documents
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