The State of Michigan has released a new consumer guide to help people know their rights when it comes to surprise medical bills.
Let’s say you have a surgery scheduled with your in-network health care provider at a local hospital. Months later, you receive an unexpectedly high bill from the hospital that includes costs for an out-of-network anesthesia provider.
It’s called surprise medical billing, or “balance billing." According to a new guide released by the Michigan Department of Insurance and Financial Services, you might not be required to cover those additional costs because of new federal and state legislation.
Anita Fox, the department's director, says consumers should receive a notice before receiving the services.
“What's supposed to happen now is if somebody's outside your network and you have no way of knowing, you need to get 14 days' notice, or they will have to charge you at the in-network cost,” Fox said.
According to the guide, consumers are advised to talk to their insurance company first when receiving surprise bills from their medical providers.
“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 you say: ‘I wasn't given the notice that there was an out-of-network charge, please explain this to me,'” Fox added.
If calling your insurance company doesn’t resolve it, Fox says to call the Department of Insurance and Financial Services consumer hotline at: 877-999-6442.
According to the guide, out-of-network providers in Michigan are not allowed to send you a surprise bill in a non-emergency situation if you are being treated at an in-network health care facility. This is because of Michigan’s surprise medical billing law that was signed into legislation in 2020. The law only applies to insurers regulated by the Department of Insurance and Financial Services and insurance purchased on the Health Insurance Marketplace.
While self-funded group health plans provided by private employers are not required to comply with Michigan's law, they are subject to the surprise billing protections under the federal No Surprises Act.
Self-funded health plans are those where an employer pays up front for each out of pocket claim instead of paying a fixed premium to an insurance carrier. To find out if your plan is self-funded through your employer, contact your employer’s human resource department.
More information is available at the Michigan Department of Insurance and Financial Services website.