On January 10, 2023, the Department of Insurance and Financial Services published a consumer guide to help consumers in the state understand the state’s surprise billing law. Act 368, signed into law in 2020, prohibits out-of-network providers in the state from billing a patient for an amount greater than the applicable in-network coinsurance, copay or deductible. Instead, the out-of-network provider must submit a claim to the patient’s insurer for an amount established in the law. This prohibition generally applies to covered healthcare services provided by an out-of-network provider in an emergency. It also applies if an out-of-network provider bills a patient after treating them at a participating health facility and the patient did not have the ability or opportunity to choose an in-network provider.
The law also requires out-of-network providers to provide a disclosure before providing a non-emergency healthcare service. The disclosure must state that the patient’s health insurer may not provide coverage for all the scheduled healthcare services and that the patient may be responsible for the cost of the services. The disclosure must also state that the provider must provide a good faith estimate of the cost of the healthcare services and that there is a right to request an in-network provider. The disclosure directs the patient to their insurer for information on in-network services.
Employers with plans governed by the state should be aware of this law. Self-insured plans in the state are not subject to the state law but may be subject to the federal No Surprises Act.
Consumer Guide » Act 368 »
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