Michigan Court of Appeals; Docket No. 105578; Published
Judges MacKenzie, Weaver, and Reilly; Unanimous; Per Curiam
Official Michigan Reporter Citation: 180 Mich App 314; Link to Opinion
STATUTORY INDEXING:
12% Interest Penalty on Overdue Benefits – Nature and Scope [§3142(2), (3)]
Providers Entitled to Charge Reasonable Amount for Services [§3157]
Prohibition Against Charging No-Fault Insurers More Than Uninsured Patients [§3157]
TOPICAL INDEXING:
Medicaid Benefits
CASE SUMMARY:
In this unanimous per curiam Opinion, the Court of Appeals rejected the argument of a no-fault insurer that it was only obligated to pay those hospital charges that would have been paid by Medicaid had plaintiff not been entitled to receive no-fault benefits as a result of an automobile accident. The court held that under Michigan law, Medicaid is available only to those who are "medically indigent." Because plaintiff was entitled to recover no-fault benefits, he was not medically indigent It is irrelevant that plaintiff would otherwise have been entitled to receive Medicaid had his injury not occurred as a result of a compensable automobile accident. The defendant primarily relied upon §3157 of the statute which states that a medical provider shall not assess charges "that exceed the amount the person or institution customarily charges for like products, services and accommodations in cases not involving insurance." The court found that this section is clear and unambiguous and permits a health care provider to receive reimbursement from a no-fault insurer for its customary charges, provided that the no-fault insurer is not being charged more than what would be charged in the case of no insurance.
The court also held that the defendant was obligated to pay interest under §3142 because the benefit was overdue and remanded the case to the trial court for determination of whether plaintiff was entitled to recover attorney fees under §3148.