MI HB4933

Amends Michigan's health insurance external review law (2000 PA 251) to expand patient protections and clarify procedures for independent review of denied health coverage claims.

Extends the deadline for filing external review requests from 60 days to 120 days after receiving notice of an adverse determination, effective December 31, 2016.

Establishes expedited external review process allowing patients with life-threatening conditions to request independent review within 10 days while simultaneously filing expedited internal grievance, with decision required within 36 hours.

Requires independent review organizations to be accredited by nationally recognized accrediting bodies and clinical peer reviewers to be specialists with current licenses and board certifications, with quality assurance mechanisms ensuring timely reviews and reviewer impartiality.

Mandates health carriers and independent review organizations maintain detailed records and submit annual reports to the Department of Insurance and Financial Services on external review requests, outcomes, and resolution times.