Physicians Health Plan of South Michigan will be transitioning its membership to Priority Health, subject to regulatory approval.

Physicians Health Plan of South Michigan Named One of the Best in The Nation by U.S.News & World Report/NCQA “America’s Best Health Plans” 2006

For the second year in a row, Physicians Health Plan of South Michigan has been named one of the best commercial health plans in the nation by the U.S.News & World Report/NCQA "America's Best Health Plan"* 2006.

iSave

PHPSM is proud to offer you iSave - our six new high deductible health plans (HDHP's). iSave features low premiums and first dollar coverage for preventive care. iSave helps you get your healthcare spending back on track. For more information, please click the title link above.

Leapfrog

Leapfrog is a program to provide information about health care safety, quality and customer value. Click the title above for more details.

Care Coordination

PHPSM Provider Complaints

PHPSM is committed to the satisfaction of its practitioners and providers as well as its members.

Practitioners and providers are encouraged to contact the Network Services Department when they experience a problem, or with questions and concerns related to their participation.

The Customer Service Department may be reached to status claims, or for member benefit and enrollment information.

Medical and pharmacy issues should be directed to the Care Management Department.

PHPSM works with practitioners and providers to answer questions and resolve problems as expeditiously as possible.

An appeal (or grievance) is a specific request to reverse an adverse determination and restriction of benefit coverage. Adverse determinations are based on:

Contract limitations
Specific benefit contract exclusions
Lack of medical information
Failure to meet established treatment guidelines and practice parameters

An explanation of the appeals process is provided with the verbal and written notification of each denial determination. An initial determination for all grievances (other than expedited, see below) is issued within 30 calendar days from receipt. However, if further medical documentation is needed, an additional 10 days are provided to PHPSM.

If you disagree with a determination made by the Care Management Department, there are grievance (appeal) opportunities available to request reconsideration of the initial determination. Additionally, you may contact the PHPSM Medical Director or the Care Management Department with any questions you may have about the clinical criteria used in the determination or to provide further information. The Practitioner/Provider and the Member make the final treatment decision.