Southeast Michigan networks clarification (narrow vs. tiered networks)

We’ve heard about some confusion between our narrow networks and our tiered networks, especially those with similar names, so we want to illustrate the difference using the example of the Southeast Michigan Partners tiered network and a narrow network, the Southeast Michigan Network. These are two different networks attached to different plans. They do not share the same providers, and they are not available to members in all the same counties.

What is Southeast Michigan Partners?

Southeast Michigan Partners is one of our tiered networks. It is available to employer groups through multiple plans in six counties:

  • Livingston
  • Macomb
  • Oakland
  • St. Clair
  • Washtenaw
  • Wayne

It includes multiple health systems in Tier 1:

  • Ascension
  • Corewell Health - East
  • Detroit Medical Center
  • Lake Huron Medical Center
  • Michigan Medicine
  • Trinity Health

Members will benefit from lower coinsurance, copays and deductibles when receiving care through a Tier 1 provider. Members still have access to the entire Priority Health network, but care received from Tier 2 providers has greater member cost-sharing.

What is the Southeast Michigan Network?

The Southeast Michigan Network is one of our narrow networks. It’s a MyPrioritySM HMO narrow network plan available to individuals under 65 and their families in three counties:

  • Macomb
  • Oakland
  • Wayne

It includes two health systems:

  • Corewell Health - East
  • Trinity Health

Members are only covered when receiving care from in-network providers, except in emergencies.

How can you tell which network a Priority Health member is part of?

If you’re confused about whether a patient is covered on the Southeast Michigan Partners tiered network or the Southeast Michigan narrow network, check one of two places:

  1. The patient’s Priority Health member ID card. Note the different details listed in the Health plan field on each card.

    SE Michigan networks news item screenshot 1.png

    SE Michigan networks news item screenshot 2.png

  2. Member Inquiry in prism. In a member’s plan information, check the “product type” listed. For members on a Southeast Michigan narrow network plan, it will say “Southeast Michigan Network.” For members on the Southeast Michigan Partners tiered network, it will say “SEMP Tiered Network,” as in the screenshot below.

    SE Michigan networks news item screenshot 3.png

How can you tell if you or another provider is in-network?

Once you know the kind of plan your patient has, you can use our Find a Doctor tool to find in-network providers. Note that you can use Find a Doc to determine if you are in the patient’s network too. 

  1. Search by plan type by clicking the yellow button in the upper right corner.

    SE Michigan networks news item screenshot 4.png
  2. Click the “Find a different plan” button.

    SE Michigan networks news item screenshot 5.png
  3. Search “Southeast Michigan Network” for the narrow network of the same name or “Southeast MI Partners” for the tiered network of the same name. Note that there are two options for “Southeast MI Partners.” Choose option A for HMO plans or POS A plans, and option B for PPO, EPO or POS B plans. (If you’re not sure whether a plan is POS A or POS B, the “Health plan” field of the member ID card will indicate either “PriorityPOS-A Southeast MI Partners” or “PriorityPOS-B Southeast MI Partners.”)

    SE Michigan networks news item screenshot 6.png
  4. You'll then see only in-network providers when you search. If a provider you search for is Tier 2 for a member in a tiered-network plan, the provider’s information box will tell you.

    SE Michigan networks news item screenshot 7.png

You can also search for providers in Find a Doctor without having a plan selected.

  1. Search for and then click the provider you want.

    SE Michigan networks news item screenshot 8.png
  2. Click the link in their information box under the “plans accepted” heading to bring up a list of the types of plans they accept.

    SE Michigan networks news item screenshot 9.png

  3. The Southeast Michigan Network will be listed under “Individual and Family Plans” if it is an accepted plan type, and “Southeast MI Partners” will be listed under “Employer Group Plans.”

    SE Michigan networks news item screenshot 10.png

What should you do to make sure members receive in-network care whenever possible?

If you’re not sure if you're in network for a member, you can use our Find a Doctor tool by looking up the member's specific plan and seeing if they're in network. When a patient needs to be referred to another provider, providers can use Find a Doctor to find in-network care. 

Need to know more about the differences between narrow and tiered networks?

Check out this helpful one-pager on narrow vs. tiered networks.