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A client of mine was injured in an auto accident and recently received a notification from DIFS stating that their health care provider has filed an appeal to DIFS' Utilization Review program. What does this mean and how should I advise them to proceed?
Any health care provider who disagrees with a Utilization Review decision made by the insurer or the Michigan Catastrophic Claims Association (MCCA) may appeal to DIFS. After a review period, DIFS will issue an order resolving the appeal to both the health care provider and the insurer or the MCCA.
If your client received a notice related to Utilization Review, it means that a health care provider has disagreed with a determination made by the auto insurer and that the provider has submitted an appeal to DIFS for a review. Neither you nor your client are required to take action. If you have questions, please contact DIFS at 877-999-6442 or DIFS-UR@michigan.gov. If your client has questions, they can contact DIFS at 833-ASK-DIFS (833-275-3437) or email@example.com.