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11/02/2020

Governor Whitmer Signs Surprise Billing Protection Legislation

MAC Worked with Bill Sponsor to Improve the Bill Package for Chiropractic Patients - HOW WILL THIS AFFECT YOUR PRACTICE?

The “Surprise Billing” Law in a Nutshell:

  • Healthcare providers must give patients advance notice that their insurer may not cover all services and that they may request care from an in-network provider.

  • Providers must advise patients that an out-of-network provider is required to give a “good-faith” cost estimate for services.

  • Patients are still responsible for customary copays and/or deductibles.

On October 22, 2020, Michigan Governor Gretchen Whitmer signed into law House Bills 4459, 4460, 4990, and 4991, legislation that would add surprise billing protections to Michigan’s Public Health Code, stopping the potential for surprisingly high out-of-network charges for health care procedures. Under the new law, providers must inform patients in advance of a scheduled procedure that their health insurer may not cover all their medical services and that they can request care from an in-network provider.

“Surprise medical billing” occurs when a patient is hit with a surprise bill for a portion of care that occurred outside his or her insurance network. An example given in committee testimony on the bill package: A person undergoing surgery might find out only upon getting a bill weeks after his or her surgery that the anesthesiologist was out-of-network, with charges much higher for that reason—and insurance covers none of it.

Nationally, there has been a call for comprehensive surprise billing protection legislation, but action in Congress has stalled, despite seemingly strong bipartisan support for comprehensive protections in both the U.S. House and Senate, necessitating state action. It is believed that as of September 2020, at least 31 states have laws protecting patients from surprise out-of-network bills, with many additional states considering legislation to address it.

MAC GR Team Worked with Bill Sponsor to Improve Legislation

The MAC was able to work with one of the bill sponsors, state Rep. Roger Hauck (R-Union Township), to improve the legislation for chiropractors and their patients. As the bill was introduced, in non-emergency care situations, written notice was required to be given 14 days before the service was performed. This would have been impossible for most chiropractic offices, forcing them to bill insurers who they had no prior relationship with and accept whatever they paid. The MAC Government Relations team was able to have this portion of the original bill removed, and now practitioners providing non-emergency care are only required to give the prescribed information when the patient calls to schedule an appointment (or other first point of contact). For how this works in practice, see below.

How Do the New Laws Affect My Practice?

The biggest difference chiropractic offices will notice under the new law is that they will have to alter their patient intake procedures. Any non-participating provider who is providing a health care service to a nonemergency patient must provide a disclosure statement to the nonemergency patient. The disclosure statement must be provided at the earliest of the following:

  • At the time of the nonparticipating provider’s first contact with the nonemergency patient regarding the health care service
  • At a scheduling or intake call for the health care service

The disclosure must be in not less than 12-point type and in substantially the form prescribed by the new law. The statement must be signed by the patient (or the patient’s representative) acknowledging that the nonemergency patient (or that patient’s representative) has received, has read, and understands the disclosure. A nonparticipating provider shall provide the nonemergency patient or that patient’s representative with a good-faith estimate of the cost of the health care services to be provided to the nonemergency patient. A copy of the disclosure must be kept on file for not less than seven (7) years after the nonemergency treatment.

A nonparticipating provider who fails to provide the disclosure as required under this section shall submit a claim to the nonemergency patient’s carrier within 60 days after the date of the health care service and shall accept from the nonemergency patient’s carrier, as payment in full, the greater of the following:

  • The median amount negotiated by the nonemergency patient’s carrier for the region and provider specialty, excluding any in-network coinsurance, copayments, or deductibles. The nonemergency patient’s carrier shall determine the region and provider specialty.
  • One hundred and fifty (150) percent of the Medicare fee for service fee schedule for the health care service provided, excluding any in-network coinsurance, copayments, or deductibles.

A nonemergency patient’s carrier shall pay this amount to the nonparticipating provider within 60 days after receiving the claim from the nonparticipating provider. The nonparticipating provider shall not collect or attempt to collect from the nonemergency patient any amount other than the applicable in-network coinsurance, copayment, or deductible.

MAC members can download a sample disclosure form on the MAC website, here.

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