Auto Payment and Billing Guidance for Health Care Providers

MAC Insurance Relations Team Recommends All Offices Familiarize Themselves with This Guidance

Yesterday, Anita Fox, Director of the Michigan Department of Insurance and Financial Services (DIFS), issued an Insurance Bulletin (2024-06-INS) regarding payment and billing guidance for health care providers in auto no-fault in light of the recent Michigan Supreme Court decision in the Andary case. The bulletin updates and supersedes a Bulletin issued last September.

On July 31, 2023, the Michigan Supreme Court issued a ruling in Andary v USAA Casualty Insurance Company, 343 Mich App 1; 996 NW2d 784 (2022) and held that the auto no-fault “reform” bills passed in 2019 do not apply to the cost of treatment provided to persons injured in motor vehicle accidents occurring before June 11, 2019. The Bulletin includes sections covering such items as claims reprocessing, timely payment, utilization review orders, the “reasonableness standard” in Michigan’s Auto No-Fault statute, and billing and coding disputes.

Moving Forward: The MAC Insurance Relations team recommends that all chiropractors who had auto no-fault patients who were injured in an auto accident prior to June 11, 2019, and whose treatment continued after that date review their claims to ensure they were paid correctly, in light of the Andary decision, subsequent lower court decisions, and this billing guidance from DIFS.

Source: Michigan Department of Insurance and Financial Services, Insurance Bulletin 2024-06-INS.  

Disclaimer: This article is meant to be information-only and does not constitute legal advice regarding any specific matter or situation. Legal information is not the same as legal advice, which is the application of law to an individual’s specific matter, situation, or circumstances. Legal advice may be given only on the basis of specific facts relayed by a client to an attorney. The MAC goes to great lengths to make sure our information is as accurate, useful, and up to date as possible. We recommend, however, that you consult an attorney if you want or need professional assurance that our information, and your interpretation of it, applies to your specific legal situation. 

MAC Insurance Relations Team Recommends All Offices Familiarize Themselves with This Guidance

Yesterday, Anita Fox, Director of the Michigan Department of Insurance and Financial Services (DIFS), issued an Insurance Bulletin (2024-06-INS) regarding payment and billing guidance for health care providers in auto no-fault in light of the recent Michigan Supreme Court decision in the Andary case. The bulletin updates and supersedes a Bulletin issued last September.

On July 31, 2023, the Michigan Supreme Court issued a ruling in Andary v USAA Casualty Insurance Company, 343 Mich App 1; 996 NW2d 784 (2022) and held that the auto no-fault “reform” bills passed in 2019 do not apply to the cost of treatment provided to persons injured in motor vehicle accidents occurring before June 11, 2019. The Bulletin includes sections covering such items as claims reprocessing, timely payment, utilization review orders, the “reasonableness standard” in Michigan’s Auto No-Fault statute, and billing and coding disputes.

Moving Forward: The MAC Insurance Relations team recommends that all chiropractors who had auto no-fault patients who were injured in an auto accident prior to June 11, 2019, and whose treatment continued after that date review their claims to ensure they were paid correctly, in light of the Andary decision, subsequent lower court decisions, and this billing guidance from DIFS.

Source: Michigan Department of Insurance and Financial Services, Insurance Bulletin 2024-06-INS.  

Disclaimer: This article is meant to be information-only and does not constitute legal advice regarding any specific matter or situation. Legal information is not the same as legal advice, which is the application of law to an individual’s specific matter, situation, or circumstances. Legal advice may be given only on the basis of specific facts relayed by a client to an attorney. The MAC goes to great lengths to make sure our information is as accurate, useful, and up to date as possible. We recommend, however, that you consult an attorney if you want or need professional assurance that our information, and your interpretation of it, applies to your specific legal situation. 

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