Surprise Medical Billing by Non-Network Providers in Michigan
“Surprise billing” occurs when a patient receives care from a provider who is not part of their health insurer’s network, often unknowingly, leaving them with large and unexpected medical bills. Effective as of October 22, 2020, health care providers in Michigan are required to give non-emergency patients advance notice that the patient’s insurer may not cover all services, resulting in the patient being personally responsible for any uncovered costs. Providers must make a “good faith” estimate of the cost for non-network services and patients have to be given the opportunity to request an in-network provider. Such disclosure form must be provided to the patient at least 14 days before services are rendered. Patients are required to sign the disclosure and the provider has to keep a copy of the notice for at least seven years.
If a non-network provider fails to make the aforementioned disclosure, or if the patient is receiving emergency care from a non-network provider, providers are required to accept the greater of the following as payment in full:
- the median amount that the patient’s insurer would pay to in-network providers for the service, or
- 150% of what Medicare would pay for the service.
Failure to comply with these new requirements could result in fines or other disciplinary actions. The amendments can be found on the Michigan Legislature’s web site.
Should you have any questions concerning surprise billing, please contact Ms. Rubin.
Anna L. Schroeder, a law clerk with Eastman & Smith who received her law degree from The Ohio State University Moritz College of Law and is awaiting bar exam results, contributed to this article.
The article in this publication has been prepared by Eastman & Smith Ltd. for informational purposes only and should not be considered legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney/client relationship.