Form FIS2326 Treating Provider Certification for Experimental / Investigational Denials - Michigan

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Form FIS2326 Treating Provider Certification for Experimental / Investigational Denials - Michigan

What Is Form FIS2326?

This is a legal form that was released by the Michigan Department of Insurance and Financial Services - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form FIS2326?
A: Form FIS2326 is the Treating Provider Certification for Experimental/Investigational Denials in Michigan.

Q: What is the purpose of Form FIS2326?
A: The purpose of Form FIS2326 is to certify that the treatment provided to a patient is not considered experimental or investigational.

Q: Who needs to complete Form FIS2326?
A: The treating provider, who is responsible for the patient's care, needs to complete Form FIS2326.

Q: What information is required on Form FIS2326?
A: Form FIS2326 requires the treating provider's information, patient's information, description of the treatment, and certification that the treatment is not experimental or investigational.

Q: Are there any fees associated with Form FIS2326?
A: There are no fees associated with Form FIS2326.

Q: What happens after Form FIS2326 is completed?
A: After Form FIS2326 is completed, it is submitted to the relevant health plan or insurance company for review and determination of coverage.

Q: Can the use of Form FIS2326 guarantee coverage for a treatment?
A: No, the use of Form FIS2326 does not guarantee coverage for a treatment. The health plan or insurance company will make the final determination based on their coverage policies.

Q: Is Form FIS2326 specific to Michigan?
A: Yes, Form FIS2326 is specific to Michigan and is used for experimental/investigational denial certification in the state.

Q: Can I appeal a denial based on experimental/investigational treatment?
A: Yes, if a treatment is denied as experimental or investigational, you have the right to appeal the decision through the health plan or insurance company's appeals process.

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Form Details:

  • Released on September 1, 2017;
  • The latest edition provided by the Michigan Department of Insurance and Financial Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form FIS2326 by clicking the link below or browse more documents and templates provided by the Michigan Department of Insurance and Financial Services.

Download Form FIS2326 Treating Provider Certification for Experimental / Investigational Denials - Michigan

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