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Insurance Plans - Michigan
Select the name of your insurance company to find out where to get forms
and to find contact information for your plan if you need to request prior
authorization or an exception.
This information was collected from the Web sites of the plans, and in
some cases from e-mails and phone calls to the plans. It is provided here
in an effort to make the information more conveniently available to you.
We do not endorse any particular plan and we are not responsible if any
plan has been inadvertently omitted from this list. We have not verified
this information. In addition, we cannot be responsible for ensuring that
the information is always up to date. Please notify
us if you are aware that any of the information provided has changed.
If you would like more detailed and current information, we suggest that
you consult the Medicare
Web site.
AETNA HEALTH INC
ALLIANCE HEALTH AND LIFE INSURANCE, CO
Where to Get Forms: Call 1-800-788-2949 and ask to have form sent,
Phone # to request Prior Authorization: 1-800-788-2949 Option 3
Phone # to request Exception: 1-800-788-2949 Option 3
Fax #: 858-790-7100
E-mail Address: customerservice@medimpact.com Updated: May 2006
BLUE CARE NETWORK OF MICHIGAN
Where to Get Forms: Call 1-800-788-2949 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-788-2949 Option 3
Phone # to request Exception: 1-800-788-2949 Option 3
Fax #: 858-790-7100
E-mail Address: customerservice@medimpact.com Updated: May 2006
BLUE CROSS BLUE SHIELD OF MICHIGAN
Where to Get Forms: Call 1-800-788-2949 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-788-2949 Option 3
Phone # to request Exception: 1-800-788-2949 Option 3
Fax #: 858-790-7100
E-mail Address: pharmservicespartd@bcbsm.com Updated: May 2006
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
COVENTRY HEALTH AND LIFE INS COMPANY
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number.
E-mail Address: Not Available
Updated: May 2006
FIDELIS SECURECARE
FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number.
E-mail Address: Not Available
Updated: May 2006
HEALTH ALLIANCE MEDICAL PLANS
Where to Get Forms: Call 1-800-788-2949 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-788-2949 Option 3
Phone # to request Exception: 1-800-788-2949 Option 3
Fax #: 858-790-7100
E-mail Address: customerservice@medimpact.com Updated: May 2006
HEALTHPLUS OF MICHIGAN
HUMANA HEALTH PLAN, INC.
MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: Not Available
Updated: May 2006
MEMBERHEALTH, INC.
MIDWEST HEALTH PLAN, INC.
Where to Get Forms: Call 1-888-654-2200 and ask to have form sent.
Phone # to request Prior Authorization: 1-888-654-2200
Phone # to request Exception: 1-888-654-2200
Fax #: Not Available
E-mail Address: EANDERSON@MIDWESTHEALTHPLAN.COM Updated: May 2006
MOLINA HEALTHCARE OF CALIFORNIA
Where to Get Forms:
Call 1-866-772-7737 for fax on demand automated phone service.
Phone # to request Prior Authorization: 1-866-549-0991
Phone # to request Exception: 1-866-549-0991
Fax #: 1-866-855-2676
E-mail Address: reed.evans@rxamerica.com Updated: May 2006
PACIFICARE LIFE AND HEALTH INSURANCE COMPANY
PARAMOUNT CARE, INC
PENNSYLVANIA LIFE INSURANCE COMPANY
Where to Get Forms: Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com
Updated: May 2006
PRIORITY HEALTH
Where to Get Forms: Call 1-888-389-6648 and ask to have form sent.
Phone # to request Prior Authorization: 1-888-389-6648
Phone # to request Exception: 1-888-389-6648
Fax #: Call 1-888-389-6648 and ask for fax number.
E-mail Address: ed.keating@priorityhealth.com Updated: May 2006
RXAMERICA, LLC
Where to Get Forms:
Call 1-866-772-7737 for fax on demand automated phone service.
Phone # to request Prior Authorization: 1-866-549-0991
Phone # to request Exception: 1-866-549-0991
Fax #: 1-866-855-2676
E-mail Address: lois.mastin@rxamerica.com Updated: May 2006
SILVERSCRIPT INSURANCE COMPANY
STERLING LIFE INSURANCE COMPANY
Where to Get Forms: http://www.foxrxcare.com/exceptions.htm
Phone # to request Prior Authorization: 1-888-369-7979
Phone # to request Exception: 1-888-369-7979
Fax #: 1-866-284-4509
E-mail Address: Not Available Updated: May 2006
UNICARE
UNITED AMERICAN INSURANCE COMPANY
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com Updated: May 2006
UNITED HEALTHCARE INSURANCE COMPANY
Where to Get Forms: Call 1-877-665-6633 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6633
Phone # to request Exception: 1-800-207-2592
Fax #: 1-866-617-6709
E-mail Address: provider.relations@walgreens.com Updated: May 2006
WELLCARE HEALTH PLANS
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