HB 4459 Summary

• Adds Article 18 to the Public Health Code to regulate surprise medical billing by nonparticipating providers in Michigan.

• Requires nonparticipating providers to accept payment from carriers equal to the greater of: (1) the median negotiated amount for the region and specialty, or (2) 150% of the Medicare fee schedule, excluding patient cost-sharing.

• Applies to emergency patients at any facility and nonemergency patients at participating facilities when they lack provider choice or were not provided required disclosures.

• Establishes a process for nonparticipating providers to claim additional 25% reimbursement for services involving "complicating factors" and allows binding arbitration through the Department of Insurance and Financial Services if carriers deny such claims.

• Requires the Department of Insurance and Financial Services to prepare annual reports on out-of-network billing complaints, carrier network adequacy, and arbitration requests; effective only if HB 4460, HB 4990, and HB 4991 are also enacted.