Press Release

*New DIFS Consumer Guide Explains Protections against 'Surprise' Medical Bills*

*Media Contact:?**Laura Hall*, (517) 290-3779, [email protected]?
*Consumer Hotline:* 877-999-6442, Michigan.gov/HealthInsurance [ [link removed] ]

*FOR IMMEDIATE RELEASE:*?January 10, 2023

(LANSING, MICH) The Michigan Department of Insurance and Financial Services (DIFS) has recently published a new consumer guide [ [link removed] ] that can help Michiganders understand their rights regarding surprise medical bills that are the result of unknowingly receiving care from an out-of-network health care provider. The new publication seeks to help consumers understand what protections might apply when they receive an unexpected medical bill after receiving medical treatment.

?Unexpected medical bills can be a shock to people, especially when they are trying to recover from illness or injury. This new publication can help consumers understand their rights under state and federal surprise billing laws and how to protect themselves from surprise bills," said *DIFS Director Anita Fox*. "DIFS is a consumer protection agency here to help answer questions or concerns that consumers might have related to their insurance. Consumers can contact DIFS Monday through Friday 8 a.m. to 5 p.m. at 877-999-6442 for information or assistance."

Surprise billing, sometimes called ?balance billing,? may occur because consumers may not have known that a medical provider was not in-network and that their health insurer would not cover the health care services at the agreed to in-network rate. Out-of-network providers typically have not agreed with the consumer?s health insurer to accept certain reimbursement rates for the health care services provided to the patient. A surprise bill occurs when the consumer was not made aware that the provider was not in-network and then bills the consumer for some or all the cost of the health care service that their health insurer did not cover, other than any applicable copay, coinsurance, deductible, or other cost-sharing. These bills can be for significant amounts of money and can cause confusion and stress for patients.

Bipartisan legislation [ [link removed](S(s3zatutdpdiwddcjpdw0oudp))/mileg.aspx?page=getObject&objectName=mcl-368-1978-18&highlight=surprise%20AND%20billing ], signed by Governor Whitmer in 2020, requires health care providers to inform consumers of the possibility of balance billing using a disclosure form sent at least 14 days before a scheduled medical service. The form must explain that the consumer's insurance company may not cover all services and that the patient would be personally responsible for any uncovered costs. As part of the notice, patients must also be given a good faith estimate of the total cost of the care they will receive, enabling them to budget for these expenses in advance or choose alternative care to meet their needs.

Michigan?s surprise medical billing law applies to insurers that are regulated by DIFS, including plans purchased on the Health Insurance Marketplace. Self-funded group health plans offered by private employers are not subject to Michigan?s law but are generally required to comply with surprise billing protections established under the federal No Surprises Act (NSA). To learn more about consumer protections under the NSA, visit CMS.gov/NoSurprises [ [link removed] ]. Consumers who do not receive the required disclosure form or who receive a surprise medical bill after receiving care should contact their health insurer as soon as possible. If a resolution cannot be reached, consumers can contact DIFS Monday through Friday 8 a.m. to 5 p.m. at 877-999-6442 or visit the DIFS website [ [link removed] ] to file a complaint.

The mission of the Michigan Department of Insurance and Financial Services is to ensure access to safe and secure insurance and financial services fundamental for the opportunity, security, and success of Michigan residents, while fostering economic growth and sustainability in both industries. In addition, the Department provides consumer protection, outreach, and financial literacy and education services to Michigan residents. For more information, visit Michigan.gov/DIFS [ [link removed] ]?or follow the Department on Facebook [ [link removed] ], Twitter [ [link removed] ], or LinkedIn [ [link removed] ].

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