23rd Jan 2023

Estimated reading time: 2 minutes

Recently the Michigan Department of Insurance and Financial Services (DIFS) released a consumer guide that helps navigate through surprise medical billing. This guide helps you understand your rights when you have received an unexpected medical bill after treatment.

Anita Fox, the Director for the Michigan Department of Insurance and Financial Services says, “Unexpected medical bills can be a shock to people, especially when they are trying to recover from illness or injury. This new publication can help consumers understand their rights under state and federal surprise billing laws and how to protect themselves from surprise bills.”

Surprise medical billing occurs when your scheduled in-network medical care unexpectedly shows an out-of-network charge from another provider on your case. If you are being treated at an in-network facility, out-of-network providers are not allowed to send you a surprise bill in non-emergency situations. You should have received notice of the out-of-network charge before the services were provided. You are supposed to receive a 14-day notice. This notice should explain that the insurance company may not cover all the charges and it should also show an estimate of the total cost of care. Typically, providers that are out of your network have not previously agreed with your insurance company to accept particular reimbursement rates for certain services that were provided. Surprise bills happen when you are not made aware that the provider is out-of-network and then you receive a bill for the services provided that your insurance company did not cover.

DIFS Director, Anita Fox, says “If you get a bill where you feel you didn’t get notice and this is an out-of-network charge, the first thing you do is you contact your insurance company and say: ‘I wasn’t given the notice that there was an out-of-network charge, please explain this to me.'” If the insurance company cannot provide the information you are looking for, then you should call the consumer helpline at the Department of Insurance and Financial Services at 877-999-6442.

This law only applies to insurers that are regulated by DIFS and insurance that is purchased on the Health Insurance Marketplace. Self-funded group health plans are not required to comply with this law; their participants are protected by the federal No Surprises Act when it comes to surprise billing.

This guide will help consumers understand what rights and protections may apply to them if they receive an unexpected medical bill after receiving treatment.

Written by Beier Howlett

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