Recently, the Michigan Senate Committee-passed version of House Bill 4459, the main bill in the Surprise Medical Billing (SMB) package, which was recently revised (S-6). The Senate is expected to consider and vote on these amendments this week.
However, even as amended, the proposed S-6 substitute for HB 4459 continues to give too much control to insurance companies, creating an uneven playing field for future in-network contract negotiations, and could significantly hinder access to care – especially in rural Michigan – just when our patients need it (and us) most.
It is possible to provide patient protections from SMBs without undermining competition and access to care. Urge Legislators to VOTE NO on any surprise medical billing legislation that does not, at a minimum, address the four issues below:
- Provide a fair fee schedule upfront, instead of forcing providers to jump through bureaucratic hoops only to ask insurers for an additional (and arbitrary!) 25% payment. This would include allowing as a benchmark a previously contracted rate, if the nonparticipating provider had a contract with the health benefit plan issuer that was terminated or expired within 3 years prior to the dispute.
- Take the patient out of the middle.
- Allow for meaningful access to an independent dispute resolution by eliminating the requirement that a provider prove that an insurance company has an inadequate network before a provider can dispute the benchmark rate.
- Allow for meaningful access to an independent dispute resolution by eliminating the Department of Finance and Insurance Services (DIFS) as the “gatekeeper” to this process, and by changing the cost of arbitration to “loser pays,” instead of splitting it 50/50 (as currently provided in the bill).
The “S-6” floor substitute for House Bill 4459, before Senators today, addresses #2 and #3. We appreciate these changes as positive steps! However, without addressing these last two issues (#1 and #4 above), as a majority of other states have already done, House Bill 4459 will likely do more harm than good.