Michigan Department of Insurance and Financial Services implements important new health insurance consumer protections
LANSING — The Michigan Department of Insurance and Financial Services (DIFS) is informing Michiganders of important new health insurance consumer protections now in place under bipartisan “surprise billing” legislation signed into law by Governor Gretchen Whitmer last year.
“Unexpected medical bills can cause patients significant stress and confusion,” said DIFS Director Anita Fox. “These new consumer protections can help prevent this problem when a patient, unbeknownst to them, receives a portion of their care from a provider outside their insurer’s network, allowing patients to focus on their own health and recovery without worrying about surprise medical bills.”
“Surprise billing” occurs when a person receives health care in a facility or from a provider that is covered by the person’s health plan, but a portion of their care is rendered by an out-of-network provider. In some instances, the person receives an unexpected bill for these out-of-network services. For example, a person who undergoes surgery may receive a bill from an anesthesiologist who was out-of-network even though the surgeon and hospital were in-network with the person’s health plan. These “surprise” bills are often for significant amounts of money that exceed charges that would be covered in-network and can cause confusion for patients who had assumed their health plan would cover their medical care at agreed to in-network rates.
Bipartisan legislation, signed by Governor Whitmer in 2020, requires health care providers to inform consumers of the possibility of surprise billing using a disclosure form sent at least 14 days before a scheduled medical service. The form must explain that the consumer’s insurance company may not cover all services and that the patient would be personally responsible for any uncovered costs. As part of the notice, patients must also be given a good faith estimate of the total cost of the care they will receive, enabling them to budget for these expenses in advance or choose alternative care. The legislation applies to most health plans.
Consumers who do not receive the required disclosure form or who receive a surprise medical bill after receiving care should contact their health insurer, and if they cannot resolve the issue, contact DIFS Monday through Friday 8 a.m. to 5 p.m. at 877-999-6442 or visit the DIFS website to file a complaint.
In addition to establishing disclosure requirements, the new law states that payment for out-of-network emergency services must be negotiated between the provider and the patient’s insurance company, and not with the patient directly. Beginning July 1, certain payment disagreements between out-of-network providers and insurers can go to binding arbitration under the law.
“It is important that consumers understand their rights under this new law,” said Fox. “DIFS is first and foremost a consumer protection agency and we are always here to help answer questions or concerns that consumers might have related to their insurance.”
The mission of the Michigan Department of Insurance and Financial Services is to ensure access to safe and secure insurance and financial services fundamental for the opportunity, security, and success of Michigan residents, while fostering economic growth and sustainability in both industries. In addition, the Department provides consumer protection, outreach, and financial literacy and education services to Michigan residents. For more information, visit Michigan.gov/DIFS or follow the Department on Facebook, Twitter, or LinkedIn.