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What You Need to Know About Surprise Billing

Unexpected medical bills are a major concern for anyone who has coverage and is injured or ill. Getting an unexpected bill for a procedure can be confusing and cause financial hardship. When this happens, people sometimes refer to it as surprise billing.

What is surprise billing?

These are situations where a member unknowingly receives care from a health care provider who doesn’t participate with a member’s health insurance. They then receive an unexpected bill for the difference between the insurer’s payment and what the health care provider charges.

Over the past several months, the state of Michigan and the federal government have taken actions to address these situations.

Actions by the state of Michigan

As of Oct. 22, 2020, a state law went into effect that prohibits surprise billing by nonparticipating professional health care providers in Michigan for emergency and some non-emergency services. Participating health care providers already agree not to bill our members for differences in their charges and what Blue Cross and BCN pay.

The state of Michigan also currently bans surprise billing for certain air ambulance services.

The federal government response

On Dec. 27, 2020, the Consolidated Appropriations Act (CAA) was signed into law and includes federal surprise billing provisions that are effective Jan. 1, 2022. These provisions prohibit surprise billing nationwide for emergency services, some non-emergency services and air ambulance.

What Blue Cross and BCN are doing  

Today, Blue Cross and BCN are processing our claims according to the state law for both fully insured plans and self-funded state or local government plans. Beginning Jan. 1, 2022, we will handle claims according to the federal law for self-funded ERISA plans, church plans, grandfathered plans and federal health plans.

We will also follow the federal law for fully insured plans and self-funded state or local government plans starting Jan. 1, but these plans will still follow the state law for provider payment rates and arbitration procedures.

Why it’s important

The surprise billing law protects our members from these types of unexpected bills and helps curb health care costs. Blue Cross continues to maintain the broadest network of providers in Michigan and ensure access to high-quality, in-network care across the country through the Blue Cross and Blue Shield Association.

We’ll continue to monitor state and federal regulations and provide information for our employer groups. You can also contact your sales representative for more information as needed.

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