Michigan Association of Health Plans

Protecting Michigan Patients Against Surprising Medical Bills + How to Take Action

MAHP strongly supports House Bills 4459 and 4460 and Senate Bills 570 and 572 which provide comprehensive protections for Michigan patients against Surprise Medical Bills and strongly encourages our legislature to act quickly to pass legislation. MAHP is encouraged by the bi-partisan efforts Representative Hauck and Representative Liberati have led in the House, as well as the bi-partisan support the bills have received in the Senate.

What Is Surprise Medical Billing?

Surprise Medical Bills occur when an insured patient receives care, without their knowledge or consent, from an out-of-network, facility-based provider while in an in-network facility. The member then receives a balance bill for the difference between the provider’s charged amount and the amount the plain reimbursed for the services. Plans consistently offer to reimburse their in-network amount or more in order to prevent this harmful practice. However, the lack of a participation agreement prevents our plans from protecting our members from Surprise Medical Bills. Research indicates more than 10% of emergency room or hospital visits lead to a Surprise Medical Bill. MAHP finds this simply unacceptable and harmful to our healthcare ecosystem.

Venture-capital backed medical groups have been purchasing facility-based provider groups and immediately ending their participation with carriers while demanding excessive rate increases. These demands are increasing costs to employers and individuals. Our plans negotiate fair-market rates to our in-network providers to deliver the best care to our insured. However, some providers have opted to fall out of network, not accepting our Plans’ fair-market rates, and taking our Plans’ payments and to look to vulnerable patients for additional payment based on the amount the provider charged. Standing by an accepting these practices places the health care ecosystem at serious risk. 

How These Bills Help Protect Michigan Patients

Enacting comprehensive protections would put Michigan in the same category as 10 other states who are leading in protecting their citizens. Those protections include taking the member “out-of-the-middle” by prohibiting billing the patient; applying the protections to all types of commercial insurance; extending protections to both the Emergency Room and Hospital settings; and providing for an adequate payment standard based on a percentage of Medicare or in-network rates. House Bills 4459 and 4460 together contain these critical protections.

Recently, the Brookings Institution called Surprise Medical Billing a “market failure.” MAHP strongly encourages the legislature to quickly solve this failure to protect Michiganders with comprehensive protections from providers who refuse to accept fair-market rates.  

How You Can Get Involved

We encourage you to contact your local legislator and voice your concern for surprise medical billing and your support for these bills. To contact your local representative, click here. And to find your local senator, click here.