Coverage Determinations and Exceptions
What is a coverage determination?
A coverage determination is a decision Michigan Complete Health (MMP) makes about whether a drug prescribed for you is covered by the plan. Coverage determinations are also called coverage decisions.
What is an exception?
If a drug is not covered in the way you would like it to be covered you can ask us to make an “exception.” An exception is a type of coverage determination. Similar to other types of coverage determinations, if we turn down your request for an exception, you can appeal our decision. When you ask for an exception your doctor or other prescriber will need to explain the medical reasons why you need the exception approved. We will then consider your request.
Asking for a coverage determination or exception
You, your doctor, or your appointed representative may file for a coverage determination, including an exception by contacting Michigan Complete Health (MMP). Please see contact information below.
- Phone: 1-844-239-7387
- TTY: 711
- Fax: 1-888-235-8551
- Mail to:
ESI Medicare Reviews
ATTN: Michigan Complete Health (MMP)
PO Box 66571
St. Louis, MO 63166
Please see below for the Medicare Prescription Drug Coverage Determination Request Form. You cannot use this form for Medicare non-covered drugs: fertility drugs, drugs prescribed for weight loss, and weight gain or hair growth.
Please call Michigan Complete Health (MMP) at 1-844-239-7387. Hours are from 8 a.m. to 8 p.m., seven days a week. TTY users call 711. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day.
Last Updated: 03/15/17