House Bill 4459

On September 30, 2020, the Michigan Senate voted to pass Surprise Billing legislation (House Bills  4459, 4460, 4990, and 4991). These bills were concurred by the House of Representatives last week. The MCEP Executive Committee delivered a letter of concern and opposition to the Governor and asked if she chose to sign this legislation, that the Department of Insurance and Financial Services (DIFS) be asked to monitor these changes for any adverse impact on physicians in Michigan. We opposed these original bills because they did not hold our patients harmless from unanticipated out-of-network bills, did not provide an avenue for the physicians to negotiate in good faith, did not create a practical dispute resolution process, or support the use of a fair and sustainable payment standard.

After discussion and questions from the Governor, the request to have DIFS monitor these changes was granted, and the Governor signed the bills yesterday afternoon.

When the bills were introduced in 2019, they banned balance billing and forced physicians and other health care providers to accept payment equal to 125% of Medicare. As a result of your advocacy efforts, these bills include a fairer fee schedule (150 percent of Medicare or the median in-network rate, whichever is greater), and the patient is removed from the middle and out-of-network providers receive direct payments from the patient’s insurer.

The MCEP Executive Committee would like to thank all the members who emailed, called, or texted their representatives.

We have been assured that we will meet with DIFS and be included in their monitoring process in 2021.

MCEP leadership was on the Hill in October to represent you at the House Committee for the Health Policy Hearing. Because there was so much testimony before the Committee, we expect to be heard in fight against legislators deciding what your reimbursement should be on October 31st. A substitute bill, raising the cap from 125% to 150% of Medicare, was accepted for consideration. Please call your legislators in the House and educate them on why they should oppose House Bill 4459 as substituted.

This newly substituted bill attempts to address surprise billing by capping all out-of-network reimbursement at the average in-network rate for the insurer or 150% of local Medicare rates, whichever is greater. This proposed substituted bill:

Does not solve the problem, which instead lies with the insurance industry, ever-increasing out-of-pocket costs, and high deductible plans; Would create a significant financial burden for many emergency departments, particularly rural ones; ultimately limit access to care; and effectively eliminate any contract negotiating power that physicians and emergency medicine provider groups have.