News & Media

Unanticipated Out of Network Billing Debate to Unfold in Michigan – What You Should Know

Thursday, September 26, 2019

Lawmakers in Michigan, in Congress and around the country are debating the appropriate recourse to address unanticipated out-of-network bills. Patients are receiving these high bills because the care they believed was covered, actually was not.

This is a problem, but it also a complex issue tied up in provider-payer negotiations and market dynamics.

Unfortunately, the sponsors of legislation introduced in Michigan – HB 4459 and 4460 – believe there is a simplistic answer, namely implementing a payment standard of 125 percent Medicare for out-of-network cases. As proposed, Michigan’s approach to out-of-network billing would constitute the most aggressive form of rate-setting in the nation.

The Michigan State Medical Society (MSMS) supports holding patients harmless from unanticipated, out-of-network medical bills and believes the most effective approach – and where we have seen robust success in other states – allows the insurers and provider to negotiate in good faith with an independent dispute resolution process in place for the rare cases when negotiations break down. We do not, however, support codifying a payment standard that could, paradoxically, lead to more widespread out-of-network cases.

We could see debate on this issue in the House of Representatives Health Policy Committee as soon as October with pending activity in the Senate as well. As we near the debate, MSMS has prepared talking points to assist members in speaking to their respective lawmakers. Also, depending on the trajectory of the debate, be on the look out for updates and action alerts.


Documents to download