Michigan Department of Insurance and Financial Services Implements Important New Consumer Health Insurance Protections | News, Sports, Jobs

LANSING – Michigan Department of Insurance and Financial Services (DIFS) briefs Michiganders on important new consumer health insurance protections now in place under bipartite framework “Surprise billing” legislation enacted by Governor Gretchen Whitmer last year.

“Unexpected medical bills can cause significant stress and confusion for patients” said DIFS director Anita Fox. “These new consumer protections can help prevent this problem when a patient unwittingly receives part of their care from a provider outside their insurer’s network, allowing patients to focus on their own health and their lives. recovery without worrying about surprise medical bills. ”

“Surprise billing” occurs when a person receives health care at a facility or provider covered by the person’s health plan, but some of their care is provided by an off-grid provider. In some cases, the person receives an unexpected bill for these off-grid services. For example, a person having surgery may receive a bill from an anesthesiologist who was off-network even though the surgeon and the hospital were in-network with the person’s health plan. These “surprise” the bills are often for large sums that exceed the costs that would be covered by the network and can confuse patients who thought their health plan would cover their medical care at the rates agreed upon in the network.

Biparty legislation, signed by Governor Whitmer in 2020, requires healthcare providers to notify consumers of the possibility of surprise billing using a disclosure form sent at least 14 days before a medical service planned. The form should explain that the consumer’s insurance company may not cover all services and that the patient would be personally responsible for all costs not covered. As part of the notice, patients should also be given a good faith estimate of the total cost of care they will receive, allowing them to budget for those expenses in advance or to 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 treatment 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 off-grid emergency services must be negotiated between the provider and the patient’s insurance company, not with the patient directly. As of July 1, certain payment disputes between off-grid providers and insurers may be subject to legally binding arbitration.

DIFS is currently seeking nominations for arbitrators to help resolve these disagreements. Information on this program, including the application form, is available on the DIFS website.

“It is important that consumers understand their rights under this new law”, said Renard. “DIFS is first and foremost a consumer protection agency and we’re always here to help answer any questions or concerns consumers might have about 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 essential to the opportunity, safety and success of Michigan residents, while promoting economic growth. and sustainability in both sectors. In addition, the Department provides consumer protection, awareness, financial literacy, and education services to Michigan residents. For more information, visit Michigan.gov/DIFS or follow the ministry on Facebook, Twitter, or LinkedIn.

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