Published in Health Care

State lawmakers pass surprise medical billing legislation

BY Tuesday, October 13, 2020 04:41pm

State lawmakers have given final approval to bipartisan legislation that aims to curtail surprise medical billing in Michigan, sending the bills to Gov. Gretchen Whitmer.

The bill package passed the state Senate by a wide margin last month and easily cleared the House. The Michigan Association of Health Plans, which supported the bills, expects Whitmer to sign them into law.

“These laws will protect Michigan residents from receiving surprise medical bills from providers who choose not to work with insurers to hold medical costs down, while assuring providers they will receive payment that is based on local market rates,” MAHP Executive Director Dominick Pallone said in a statement. “Michigan’s surprise medical billing laws will be one of the most comprehensive packages passed to date, giving Michigan families assurance that their health insurance will cover agreed upon treatment and they will not be ‘surprised’ by high charges for common procedures.”

Surprise billing occurs when a patient receives care from a physician who does not contract with their health insurer and is considered an out-of-network provider. The situation can leave patients with large medical bills when they receive care, often unknowingly, from a provider who is not part of their health insurer’s established network.

The legislation would require care providers to inform patients in advance of a scheduled procedure that their health insurer may not cover all of their medical services and that they can request care from an in-network provider. The notice must inform the patient that a non-participating provider must provide them “a good-faith estimate of the cost of the health care services to be provided.”

In emergency situations, the out-of-network provider would have to accept payment at the median amount within the region that a health insurer pays an in-network provider, or accept 150 percent of what Medicare pays for a medical service, whichever is greater.

Patients would still have to pay their customary copays or deductibles built into the health insurance coverage.

The legislation also would allow care providers to request added payment for care in emergency cases and establish an appeals process within the Michigan Department of Finance and Insurance Services if denied.

Surprise billing legislation was first introduced in spring 2019, and lawmakers have worked since then to fashion a final package. The effort gained the attention of national advocacy groups involved in the issue, some of which consider the Michigan legislation a national model, as MiBiz previously reported.

The effort to pass the bills in Lansing gained momentum after federal surprise billing legislation stalled in Congress.

“We did the right thing in Michigan by passing our own bill,” said Jeff Romback, deputy director of policy and planning for the MAHP.

Physician groups advocated against the bills, arguing that they would give health insurers too much power in negotiating reimbursement contracts.

In a Sept. 30 statement after the Senate passed the bills, the Michigan State Medical Society cited changes that had sought to keep patients out of the dispute between insurers and care providers and an arbitration process if a request for additional payment for emergency situations were denied.

The Medical Society called those additions “significant improvements.”

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