Emergency Episode: Michigan’s Surprise Billing Legislation Needs Fixing

1. They will cap the required billing to 125% of what Medicare bills for the service provided.
2. They will not allow for any professionals to arbitrate or find a resolution with insurance companies.
3. It exempts hospitals from this bill and only involves professionals (MDs, DOs, DDS, DPMs, CRNAs, NPs, PAs, etc.).

The result of this law would give the insurance companies the power to set all rates with health professionals in the state since there is no recourse allowed for disputes. Certain services and specialties would be affected more than others as 125% of Medicare is extremely low for professions that rely on commercial carriers to help pay for the losses sustained by government payers.

The immediate impact would be a loss of professionals who would just leave the state to where the market price on their value would be anywhere from 20-80% greater. It would then cause massive shortages in certain specialties requiring significant subsidies to find people to provide the care. In short, it would be a disaster.

Fortunately, the fix would only require removing the arbitrary limit based on Medicare and allowing independent arbitrators to determine a fair rate between the insurance companies and health professionals. This has been shown to work well in New York. A detailed plan on how to pressure our legislators can be found in the show and the links below.