Michigan Billing Rights

Additional State-Law Protections for Patients with State-Regulated Health Plans

• Under certain circumstances established in Michigan’s surprise medical billing law, out-of-network providers are not allowed to bill you for an amount greater than your applicable in-network coinsurance, copay, or deductible. Instead of billing you, the out-of-network provider must submit a claim to your insurer for an amount that is established in the law. Generally, the prohibition on surprise billing applies to covered health care services provided to you by an out-of-network provider in an emergency situation.
• Additionally, out-of-network providers are prohibited from surprise billing you in a non-emergency situation if you are treated at a participating health facility and if you did not have the ability or opportunity to choose an in-network provider. Out-of-network providers must give you a disclosure before providing the non-emergency health care service. The disclosure must notify you that your health insurer may not provide coverage for all of the scheduled health care services and that you may be responsible for the cost of the services. The disclosure must also state that the provider will give you a good faith estimate of the cost of the health care services and inform you of your right to request an in-network provider and to contact your insurer for information on in-network services. If the out-of-network provider fails to give you the disclosure before your non-emergency service, as required under the law, the out-of-network provider is prohibited from billing you for any amount greater than your applicable in-network coinsurance, copay, or deductible.
• Additionally, Michigan law states if you consent to receive nonemergency care from an out-of-network provider, the balance billing prohibition does not apply. These protections apply to any patient covered by a Michigan health benefit plan and a self-funded plan established or maintained by the state or local unit of government for its employees.
• Michigan’s surprise medical billing law applies to insurers that are regulated by DIFS, including plans purchased on the Health Insurance Marketplace. Self-funded group health plans offered by private employers are not subject to Michigan’s law but are generally required to comply with surprise billing protections established under the federal No Surprises Act (NSA). To learn more about consumer protections under the NSA, visit CMS.gov/NoSurprises.

Filing a Complaint

Consumers who do not receive the required disclosure form or who receive a surprise medical bill after receiving care should contact their health insurer as soon as possible. If a resolution cannot be reached, consumers can contact DIFS Monday through Friday 8 a.m. to 5 p.m. at 877-999-6442 or visit the DIFS website at www.michigan.gov/difs to file a complaint.