Meridian Health Plan of Michigan, Inc. claim denials in Michigan: the federal figures
Meridian Health Plan of Michigan, Inc. denied 17.5% of in-network claims in Michigan — 129,724 claims out of 741,382. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Meridian Health Plan of Michigan, Inc.) | 211 | 58.8% |
| External review (independent) | — | — |
What Meridian Health Plan of Michigan, Inc. denies most
The most common denial reason recorded for Meridian Health Plan of Michigan, Inc. plans in Michigan is service excluded from the plan. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Service excluded from the plan | 58,756 | 25.6% |
| Administrative reason | 40,362 | 17.6% |
| Referral required | 28,813 | 12.6% |
| Other reasons | 24,580 | 10.7% |
| Benefit limit reached | 24,240 | 10.6% |
| Not medically necessary | 21,299 | 9.3% |
| Provider out of network | 21,155 | 9.2% |
| Member not covered | 10,057 | 4.4% |
What to do if Meridian Health Plan of Michigan, Inc. denied your claim
- Get the reason in writing. The denial notice must state the specific reason and the plan provision behind it. If it does not, request it — you are entitled to it free of charge.
- File the internal appeal. Generally within 180 days of the denial notice. Meridian Health Plan of Michigan, Inc. overturned 58.8% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Meridian Health Plan of Michigan, Inc.. Generally you have 4 months from the final internal denial. This is the step nearly everyone skips.
- Ask for expedited review if waiting would seriously jeopardise your health. That timeline is days, not months.
Everything you need for your Meridian Health Plan of Michigan, Inc. appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
Questions
Is Meridian Health Plan of Michigan, Inc.'s denial rate high?
17.5% against a national average of 16% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
Does appealing cost anything?
The internal appeal is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25.
Can Meridian Health Plan of Michigan, Inc. ignore the external decision?
No. External review decisions are binding on the plan.