Today, the Michigan Senate Committee on Insurance and Banking is scheduled to consider out-of-network (OON) legislation (HB 4459) that bans balance billing and requires an insurer to reimburse an OON provider at 150% of Medicare.
On June 24, the bill passed the House and referred to the Senate Committee on Health Policy and Human Services, however due to the recent re-referral to the Insurance Committee the provider coalition believes these actions signal an attempt to rush the legislation through the Senate.
We expect amendments to be offered either in committee or on the Senate floor that:
- Require insurers to reimburse providers directly;
- Require OON reimbursement at 115% of the median in-network rate in 2017, adjusted for inflation;
- Allow bundling of similar claims for similar services; and
- Require independent dispute resolution (IDR) that considers prior network rates between the parties.