News & Media

Surprise, Out-of-Network Billing Legislation Passes Michigan Senate

Wednesday, September 30, 2020

On September 30, 2020, the Michigan Senate voted to pass Surprise Billing legislation (House Bills 4459, 4460, 4990, and 4991).  It has been an uphill battle as evidenced by the wide margin of affirmative votes for the bills.  However, thanks to grassroots advocacy and the willingness of the Michigan Senators to consider our priority amendments, the Michigan State Medical Society (MSMS) and several specialty societies were able to secure two major improvements to the legislation.  The bills return to the House of Representatives for a concurrence vote.  If approved, they will be sent to the Governor for her signature, and if signed, will become law.

Throughout the process, the physician community expressed opposition to language in House Bills 4459 and 4460 and offered alternative language for consideration.  Some modifications were made, but it became evident that a total rewrite was not an option.  Therefore, when House Bills 4459 and 4460 were reported out of Senate Committee, MSMS focused our advocacy on the two biggest problems identified by the provider community - - the patients remained in the middle of the dispute and providers had no recourse in emergency situations for additional payment.  Thanks to the diligent work of the Michigan Senate, those two major issues were fixed through the adoption of floor substitutes.

When the bills were introduced in April of 2019, they simply banned balance billing and forced physicians and other health care providers to accept payment equal to 125 percent of Medicare.  As a result of tireless advocacy efforts, these bills include a fairer fee schedule (150 percent of Medicare or the median in-network rate, whichever is greater), the patient is removed from the middle and out-of-network providers get direct payments from the patient’s insurer, and in emergency cases providers are able to request additional payment and have access to arbitration if that additional payment is denied. These are significant improvements and all involved in advocating for and ensuring their adoption are to be commended.