DELEG - PRIRA Cases

Department of Energy, Labor & Economic Growth

Michigan.gov, Official Web Site for the State of Michigan

Michigan.gov Home	DELEG Home \| Sitemap \| Contacts \| Online Services \| Agencies


>	Consumer Services

>	Industry Services

>	Licensing

>	Statutes, Rules and Regulations

>	Hearings and Decisions

	Final Decisions

	PRIRA Cases

	Declaratory Rulings

	Commissioner's Orders

	Public Hearings

	Prohibitions and Enforcement Actions


>	Bulletins

>	Forms

>	Publications

>	Who We Regulate

>	Frequently Asked Questions

>	Related Links

Printer Friendly Text Only Version

Text Version

Share this link:

More archives for:
PRIRA Cases: 2009 | 2008 | 2007 | 2003 | 2002

2009:			August - July - June - May - April - March - February - January
	August
		• 20 -	UNICARE 105366 - Pre-existing condition limitation
		• 12 -	AMERICAN COMMUNITY 106048 - Covered benefit; inpatient mental health care
		• 12 -	USHL 106108 - Covered benefit; endodontic treatment
		• 12 -	USHL 105998 - Out-of-network provider; ambulance transport
		• 12 -	BCBSM 104584 - Psychotherapy; eligible provider
		• 12 -	GUARDIAN LIFE 103798 - Medical necessity; dental care
		• 12 -	BCBSM 103907 - Out-of-network provider; sanctions
	July
		• 29 -	MOLINA 105234 - Medical necessity; cranial helmets
		• 22 -	PHPMM 104655 - Medical necessity; genetic testing
		• 22 -	HAP 104523 - Out-of-network services; inpatient mental health care
		• 22 -	AETNA 103972 - Experimental services; serological tests
		• 22 -	BLUE CARE NETWORK 103882 - Medical necessity; reconstructive breast surgery
		• 22 -	UNITED HEALTHCARE 103675 - Out-of-network services; MRI
		• 22 -	BCBSM 102827 - Deductible; office visits
		• 22 -	BCBSM 102388 - Covered benefit; gait analysis
		• 22 -	GRAND VALLEY 105145 - Deductible; emergency room services
		• 10 -	BCBSM 102851 - Covered benefit; dental implants
		• 09 -	PRIORITY HEALTH 104865 - Medical necessity; drug formulary alternative
		• 07 -	UNITED HEALTHCARE 104112 - Medical necessity; drug formulary alternative
		• 07 -	BCBSM 101945 - Experimental treatment; applied behavioral analysis
		• 07 -	MIDWEST SECURITY 103173 - Medical necessity; acne treatment
		• 07 -	BCBSM 102738 - Out-of-network surgery; breast reconstruction
	June
		• 26 -	USHL 102666 - Covered benefit; ambulance transport
		• 26 -	BCBSM 102481 - Out-of-network durable medical equipment; mastectomy prosthesis
		• 26 -	BCBSM 102546 - Covered benefit; immunizations
		• 26 -	BCBSM 102500 - Deductible; mammogram
		• 26 -	AETNA 102850 - Medical necessity; Doppler velocimetry study
		• 26 -	BCN 104772 - Out-of-network services; mental health care
		• 26 -	PRIORITY HEALTH 104781 - Covered benefit; dental care
		• 26 -	HUMANA 102718 - Out-of-network services; emergency room care
		• 15 -	BCBSM 102177 - Pre-existing condition; cancer treatment
		• 15 -	BCBSM 102213 - Co-payment; responsible party
		• 15 -	AETNA 103060 - Laboratory services; copayment
		• 15 -	HAP 103782 - Out-of-network durable medical equipment; cranial band
		• 15 -	AETNA 103991 - Covered benefit; sinus surgery
		• 15 -	USHL 104041 - Covered benefit; ambulance transport
		• 15 -	TRUSTMARK 104420 - Medical necessity; inpatient substance abuse therapy
		• 15 -	JOHN ALDEN 104807 - Covered benefit; fertility services
		• 15 -	BCBSM 102481 - Out-of-network durable medical equipment; mastectomy prosthesis
		• 15 -	AETNA 104490 - Out-of-network services; emergency room care
		• 11 -	USHL 104440 - Out-of-network provider; anesthesiologist
		• 11 -	USHL 103828 - Medical necessity; skilled nursing care
		• 11 -	BCBSM 102383 - Non-participating provider; substance abuse treatment
		• 11 -	BCBSM 102330 - Pre-existing condition; sinus surgery
		• 11 -	BCBSM 101979 - Durable medical equipment; continuous glucose monitor
		• 01 -	BCBSM 101903 - Physical therapy; policy limits
		• 01 -	BCBSM 102087 - Experimental procedure; esophageal impedance testing
		• 01 -	BCBSM 102153 - Medical necessity; nuclear stress test
		• 01 -	PRIORITY HEALTH 103040 - Bariatric surgery; preconditions
		• 01 -	BCN 103447 - Healthy Living program; participation requirements
		• 01 -	UNITED HEALTHCARE 104051 - Surgery; out-of-network coverage
		• 01 -	PHPMM 104292 - Excluded benefits; nutritional supplements
	May
		• 18 -	BCBSM 101133 - Out-of-network surgery; payment amount
		• 11 -	CONSUMERS LIFE 103820 - Medical necessity; MRI
		• 11 -	BCN 103429 - Covered benefit; dental care
		• 11 -	BCN 103371 - Out-of-network services; preauthorization requirement
		• 11 -	BCBSM 102000 - Out-of-network surgery; copayment amount
	April
		• 30 -	BCN 103452 - Wellness program; participation requirements
		• 30 -	MOLINA 102853 - Medical necessity; power wheelchair
		• 29 -	BCBSM 101999 - Covered benefit; preventive care
		• 29 -	BCBSM 102082 - Covered benefit; dental implants
		• 29 -	GOLDEN RULE 102558 - Pre-existing condition limitation
		• 29 -	TIME 102725 - Medical necessity; chiropractic care
		• 29 -	HAP 103510 - Out-of-network services; surgery
		• 29 -	HUMANA 103310 - Radiological services; deductible
		• 29 -	TRUSTMARK 103012 - Medical necessity; chiropractic care
		• 21 -	HEALTHPLUS 103150 - Medical necessity; home stair lift
		• 21 -	TIME 103292 - Outpatient services; benefit cap
		• 20 -	BCBSM 101132 - Medical necessity; continuous passive motion machine
		• 20 -	BCBSM 101730 - Preventive care; deductible
		• 20 -	BCBSM 101921 Out-of-network services; surgery
		• 20 -	AMERITAS 102664 - Proof of loss
		• 20 -	AETNA 103035 - Medical necessity; Doppler velocimetry studies
		• 20 -	HUMANA 103036 - Radiological services; deductible
		• 20 -	PHPMM TPA 103508 -Covered benefits; mental health visits
		• 06 -	BCBSM 101599 - Medical necessity; emergency care
		• 06 -	BCBSM 101882 -Out-of-network services,; emergency care
	March
		• 30 -	TIME 102976 - Medical necessity; chiropractic treatment
		• 30 -	GOLDEN RULE 102876 - Covered benefit; outpatient surgery
		• 30 -	MIDWEST SECURITY 102979 - Covered benefit; gynecomastia
		• 30 -	BCBSM 101789 - Covered benefit; routine physical
		• 30 -	MIDWEST SECURITY 102455 - Medical necessity; chiropractic treatment
		• 30 -	AETNA 102559 - Covered benefit; chiropractic treatment
		• 30 -	USHL 102793 - Covered benefit; out-of-network ambulance service
		• 24 -	MIDWEST SECURITY 103038 - Out-of-network surgery
		• 20 -	BCBSM 101715 - Covered benefit; nonpanel surgery
		• 20 -	BCBSM 101654 - Covered benefit; physical therapy
		• 20 -	BCBSM 101652 - Covered benefit; dental care
		• 20 -	JOHN ALDEN 102685 - Out-of-network services; emergency care
		• 20 -	WORLD 102862 - Out-of-network surgery; usual and customary charge
		• 20 -	USHL 103346 - Experimental treatment; Botox injection for migraine
		• 20 -	UNITED HEALTHCARE 103750 - Medical necessity; mental health partial hospitalization
		• 19 -	UNITED HEALTHCARE 102737 -Policy exclusion; alcohol and fighting
		• 19 -	BCBSM 101651 - Covered benefit; antineoplastic infusion pump
		• 19 -	BCBSM 101134 - Medical necessity; residential mental health treatment
		• 18 -	BCN 102650 - Covered benefit; in vitro fertilization
		• 16 -	AMERICAN MEDICAL 90898 - Covered benefit; mental health treatment
		• 16 -	BCBSM 101615 - Covered benefit; dental implants
		• 16 -	BCBSM 101586 - Covered benefit; orthodontic care
		• 16 -	WORLD 102684 - Preexisting condition limitation
		• 16 -	PRIORITY HEALTH 102499 - Medical necessity; prophylactic mastectomies
		• 12 -	HUMANA 101932 - Covered benefit; thermal massage bed
		• 12 -	HUMANA 102724 - Covered benefit; out-of-network psychotherapy
	February
		• 27 -	GUARDIAN 102521 - Covered benefit; dental bridge
		• 27 -	JOHN ALDEN 101138 - Experimental or investigational treatment; erectile dysfunction
		• 27 -	MIDWEST SECURITY 102298 - Medical necessity; pain relief injections
		• 27 -	HUMANA 101768 - Covered benefit; physical therapy
		• 27 -	USHL 101656 - Covered benefit; out-of-network ambulance transport
		• 27 -	BCBSM 101348 - Covered benefit; speech therapy
		• 25 -	TIME 101817 - Pre-existing condition limitation
		• 24 -	TRUSTMARK 101353 - Covered benefit; dental care
		• 24 -	UNITED HEALTHCARE 101766 - Out-of-network surgery
		• 24 -	BCBSM 101139 - Out-of-network surgery
		• 24 -	BCBSM 100924 - Covered benefit; immunization
		• 23 -	BCBSM 101096 - Covered benefit; endodontic care
		• 23 -	BCBSM 100841 - Out-of-network surgery
		• 23 -	BCBSM 101025 - Out-of-network provider; home infusion therapy
		• 23 -	PHPMM 102516 - Out-of-network consultation
		• 17 -	BCBSM 100784 - Experimental treatment; vagus nerve stimulation
		• 17 -	GOLDEN RULE 101509 - Pre-existing condition limitation
		• 17 -	BCBSM 101000 - Covered benefit; occupational therapy
		• 09 -	BCN 102832 - Medical necessity; electroconvulsive therapy
		• 06 -	BCN 101440 - Out-of-network surgery
	January
		• 30 -	PHPMM 102069 - Covered benefit; office visit
		• 30 -	BCBSM 100883 - Covered benefit; immunizations
		• 23 -	BCBSM 100834 - Covered benefit; infant formula
		• 23 -	UNITED HEALTHCARE 89601 - Out-of-network service; surgery
		• 22 -	BCBSM 100237 - Covered benefit; dental care after accident
		• 20 -	BCBSM 100178 - Policy exclusion; diabetes care device
		• 20 -	BCBSM 90587 - Covered benefit; jaw surgery
		• 20 -	BCBSM 87766 - Experimental treatment; radio frequency ablation therapy
		• 20 -	BCBSM 100388 - Policy exclusion; feeding/speech therapy
		• 20 -	HUMANA 100671 - Experimental treatment, Botox treatment for urology disorder
		• 20 -	PARAMOUNT 100681 - Laser treatment for skin disorder, policy exclusion
		• 20 -	PHPMM 100923 - Out-of-network service; endocrinologist
		• 20 -	GOLDEN RULE 100782 - Treatment for pregnancy complications, policy exclusion
		• 20 -	USHL 100893 - Medical necessity; air ambulance transport
		• 20 -	BCN 101240 - Out-of-network service; spinal surgery
		• 20 -	TIME 101852 - Covered benefit; emergency room services
		• 20 -	PRIORITY HEALTH 101880 - Covered benefit; foot orthotics
		• 20 -	PRIORITY HEALTH 102034 - Out-of-network service; mental health therapy
		• 20 -	BCN 101962 - Wellness program eligibility
		• 13 -	HAP 90919-Prescription drug restrictions
		• 06 -	HAP 101515-Coordination of benefits
		• 06 -	HAP 101369-Out-of-network service; eye surgery
		• 06 -	PRIORITY HEALTH 101071-Wellness program eligibility


	Quick Links
•	OFIR Administrative Rules
•	Michigan Compiled Laws
•	Michigan Legislature
•	Attorney General Opinions