Michigan Surprise Billing Law and You

Michigan's surprise billing law aims to protect patients from unexpected medical bills.

The law applies to emergency services, including air ambulances and out-of-network care.

You're now protected from surprise medical bills for emergency services, including air ambulances and out-of-network care.

The law requires health insurance companies to cover emergency services at in-network rates.

This means you won't receive a surprise bill for emergency services, even if the provider is out of network.

The law also applies to out-of-network care received at in-network facilities, such as hospitals and doctor's offices.

Balance billing, also known as surprise billing, can be a major financial shock. It happens when you see a doctor or provider who isn't in your health plan's network, and they bill you for the difference between what your plan pays and the full amount charged for a service.

You might be surprised to learn that you can't be balance billed for emergency services from an out-of-network provider or facility. The most they can bill you is your plan's in-network cost-sharing amount.

Certain providers at in-network hospitals or ambulatory surgical centers may be out-of-network, but they can't balance bill you for emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services.

You're never required to give up your protections from balance billing, so don't feel pressured to accept an out-of-network provider's bill. You have the right to choose a provider or facility in your plan's network.

You're protected from surprise bills for emergency services, even if you get them from an out-of-network provider or facility. The most they can bill you is your plan's in-network cost-sharing amount.

If you get emergency services from an out-of-network provider, you can't be balance billed unless you give written consent and give up your protections. This includes services you may get after you're in stable condition, unless you explicitly agree to it.

You're also protected from surprise bills for certain services at in-network hospitals and ambulatory surgical centers. Out-of-network providers like emergency medicine, anesthesia, and radiology can't balance bill you.

These providers can't ask you to give up your protections not to be balance billed. You have the right to choose a provider or facility in your plan's network.

You're never required to give up your protections from balance billing. You can stick with your in-network plan and avoid surprise bills.

Rivet Health Law has been helping physicians understand the Michigan Surprise Billing Law since its enactment.

You can't be balance billed for emergency services from an out-of-network provider or facility, and the most they can bill you is your plan's in-network cost-sharing amount.

To avoid surprise medical bills, it's essential to understand your rights and protections. You're protected from balance billing for emergency medical conditions and services from out-of-network providers at in-network hospitals or ambulatory surgical centers.

You're never required to give up your protections from balance billing, and you can choose a provider or facility in your plan's network.

You don't have to navigate the surprise billing law alone. Rivet Health Law has been helping physicians understand it since it was enacted, including the Federal No Surprise Act.

If a provider believes the health plan incorrectly calculated the median negotiated amount, they may request a recalculation review with the Department of Insurance and Financial Services (DIFS).

Out-of-network providers can still balance bill patients under certain circumstances, but only if they provide a proper notice and obtain consent to do so. This notice must be given at least 14 days before providing services or as soon as possible if services are scheduled less than 14 days in advance.

A signed disclosure must be retained by the provider for a minimum of 7 years. You're never required to give up your protections from balance billing, and you also aren't required to get out-of-network care.

Arbitration is a viable option for nonparticipating providers who feel unfairly reimbursed for services provided to emergency patients with complicating factors.

Arbitration is only available if the payer denies a claim seeking the additional 25% reimbursement.

The nonparticipating provider must file a written request for binding arbitration with DIFS on the Request for Binding Arbitration form.

This option allows providers to seek a fair resolution to reimbursement disputes in a timely and efficient manner.

You're protected from surprise medical bills for emergency services, including those you receive after being stabilized, unless you give written consent to be balance billed.

Emergency medical conditions are taken seriously, and you won't be balance billed for emergency services, even if the provider is out-of-network.

If you get services from an in-network hospital or ambulatory surgical center, certain providers may be out-of-network, but they can't balance bill you for services like emergency medicine, anesthesia, and radiology.

You won't be asked to give up your protections from balance billing for these services, and you have the right to choose an in-network provider or facility.