State Helping to Hold Down Surprise Medical Billing Costs

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Surprise medical billing is the concept where the patient receives undesired and unpleasant invoices with hefty amounts in the case if the patient is getting the treatment from a doctor, hospital, or healthcare system not inclusive in the insurer’s network.

Michigan Lawmakers and Governor Gretchen Whitmer assembled to demolish the whole concept of surprise medical billing.

This issue of surprise medical billing was addressed by Congress in the waning days of December, to ban the surprise medical billing in the federal pandemic legislation. However, the federal solution on this issue is far less valuable to the consumers than the Michigan approach.

The Michigan Association of Health Plans is representing many of the major health insurers in the state as well as many of the Medicaid managed care insurers of the state. Their top priority was to get patients out of these payment fights between the insurers and the healthcare providers, and they were an early advocate of a strong policy against the surprise medical billing.

The patients were often complaining about the health plans regarding the surprise medical bills from the healthcare providers as they were able to make more money by just refusing to talk or negotiate with the insurers over the bills. Rather, they were billing the patients after the operation or medical treatment with an amount higher than the other healthcare providers charging way less for the same treatment.

The Michigan Association of Health Plans came with a simple solution which was ultimately adopted in Michigan. The solution was that the healthcare provider, if not covered, has to submit the bills to the insurer and not the patient as well as have to submit the payment based on a fee schedule if the agreement on the payment is not fulfilled.

Whereas, Congress came with the solution, the federal law, which said that in the case of surprise billing the provider and insurer can go into arbitration. This law will not be used for most of the Michigan procedures.