How to appeal an IVF insurance denial in Michigan

Michigan has no law requiring insurers to cover IVF or infertility treatment. Medicaid pays for diagnostic testing to identify infertility but not for treatment. A bicameral bill (SB 922 / HB 5904) that would require insurer coverage of IVF and IUI starting 2027 was introduced in April 2026 and remains in committee as of September 2026.

How to appeal a denial

Internal appeal — you have 180 days from the denial to file. The plan must decide within 30 days (before service) or 60 days (after service); 72 hours if urgent.
External review — available for at least 4 months after the final internal denial, for medical-necessity and "experimental" denials (PGT-A, ICSI, step therapy). An independent reviewer decides within 45 days. Contractual exclusions are not eligible for external review — those go to the regulator as a complaint.
Regulator — Michigan Department of Insurance and Financial Services (DIFS). Michigan Patient's Right to Independent Review Act external review (MCL 550.1901 et seq.) via DIFS File a complaint. Copy the regulator on every appeal letter; clinics report it speeds things up.

If your plan is self-funded, skip the state regulator: your appeal runs under ERISA and complaints go to the U.S. Department of Labor's Employee Benefits Security Administration.

Common denial reasons and what to argue

Step therapy / prior-treatment requirements — check your plan's own Summary Plan Description or clinical policy for its step-therapy criteria and ask the payer for its bypass criteria (age 38+, tubal factor, stage III–IV endometriosis, severe male factor are common).
Benefit limits — if your employer voluntarily covers fertility care, the denial is governed entirely by the plan document, not state law; ask for the exact clause the denial relied on.
'Experimental' (PGT-A, ERA, ICSI without male factor) — eligible for external review; ask the clinic for a medical-necessity letter. Success is limited for PGT-A.
Medication routing — many denials are the wrong pharmacy or a missing prior auth, not a coverage decision. Ask the specialty pharmacy to re-run with prior auth.
AI-only review — several states now bar insurers from denying on medical necessity without a physician's individualized review; ask in writing whether AI was the sole basis.

Where people get surprised

Michigan Medicaid covers infertility screening/diagnosis only — members still pay out of pocket for IVF, IUI, or any actual treatment.
SB 922/HB 5904 is not law — nothing is required of any Michigan insurer today; check with RESOLVE or DIFS for the bill's current status before assuming coverage.
An earlier bill with similar goals (SB 1182, 2024) was introduced in the prior legislative session and did not pass — 2026's SB 922/HB 5904 is a new attempt, not a revival with guaranteed passage.
Voluntary employer fertility riders often carry a lifetime dollar maximum that includes medications; ask whether IUI is required before IVF is authorized (step therapy).

What may change

MI SB 922 (2026) — Would require any insurer that delivers, issues, or renews a health insurance policy in Michigan to cover IVF and IUI, without discrimination based on age, ancestry, domestic partner status, gender expression, or marital status; excludes medical costs of a surrogate after embryo transfer. Sponsored by Sen. Stephanie Chang (D-Detroit). Status: Introduced 2026-04-23; referred to the Senate Finance, Insurance, and Consumer Protection Committee; pending as of 2026-09-06.. Would take effect 2027-01-01.
MI HB 5904 (2026) — House companion to SB 922, sponsored by Rep. Samantha Steckloff (D-Farmington Hills); same intent of requiring insurer coverage of IVF/IUI. Status: Introduced 2026-04-28; referred to the House Committee on Insurance; pending as of 2026-09-06.. Would take effect 2027-01-01.

Sources

This page explains public coverage rules and typical prices as of the dates shown. It is an estimate and an interpretation, not a coverage decision by your plan, and not legal, medical, tax, or insurance advice. Your plan documents control. We never store what you enter here unless you choose to save a plan.