Act Now! Michigan Out-of-Network Reimbursement Legislation

Today, ACOEP learned through EDPMA that the Michigan House Committee on Ways and Means will consider out-of-network legislation (HB 4459) that bans balance billing and requires reimbursement at 125% of Medicare. We urge our Michigan-based members to contact the committee members listed below, and ask them to OPPOSE the legislation, as this legislation would lead to a significant decrease in reimbursement for emergency care, likely reducing the number of physicians on the emergency department floor and increasing wait times. Click here for more information and to view contact information:

The Committee Chair is expected to propose an amendment that would provide for reimbursement at the greater of (1) the plan’s average in-network rate or (2) 150% of Medicare. Arbitration is available in a very narrow set of circumstances.  Although this amendment is a slight improvement, it neither ensures sustainable reimbursement nor accessible and unbiased arbitration.  .

We urge our members to contact the committee members listed below and ask them to OPPOSE the legislation, even if the Chair’s amendment is adopted. The final language that passes committee must ensure sustainable reimbursement and include accessible and unbiased IDR.

Talking Points for Your Telephone Calls and Emails:

1. Tell the Representative or their staff your name, your group or company name, and the MI address linked to the residence or business, which MI hospitals you serve, and an estimate of the number of MI patients your group/company serves each year.
2. The current pandemic poses a serious financial threat to emergency departments. This legislation would lead to a significant decrease reimbursement for emergency care, likely reducing the number of physicians on the emergency department floor and increasing wait times.
3. Commercial reimbursement must be both sustainable and commercially reasonable to ensure patients continue to have timely access to emergency care.

Any compromise must take patients out of the middle and include an IDR process that is both transparent and unbiased