Michigan Court of Appeals; Docket No. 74314; Published
Judges Danhos, T.M. Burns, and Megargle; Unanimous; Per Curiam
Official Michigan Reporter Citation: 139 Mich App 266; Link to Opinion 
STATUTORY INDEXING:
Coordination with Other Health and Accident Medical Insurance [§3109a]
Providers Entitled to Charge Reasonable Amount for Services [§3157]
Prohibition Against Charging No-Fault Insurers More Than Uninsured Patients [§3157]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous per curiam Opinion regarding an issue of major import, the Court of Appeals held that a participating health care provider under a Blue Cross/Blue Shield health care plan who signs a reimbursement agreement with Blue Cross/Blue Shield stating that the provider will accept payment from Blue Cross as payment in full for services rendered, is not legally entitled to recover the unpaid excess from the patient's no-fault insurance company. To permit health care providers to recover this excess balance from their patient's no-fault insurance company after contractually agreeing to accept Blue Cross reimbursement as full payment, "would contravene public policy."
In support of its holding, the Court of Appeals cited the legislative history regarding §3109a, which is the section that authorizes coordinated no-fault policies. Moreover, the Court held that permitting recovery in excess of the prescribed reimbursement rate for services rendered to no-fault patients collides directly with the spirit of §3157 which says that charges assessed by medical care providers "shall not exceed the amount the person or institution customarily charges for like products, services and accommodations in cases not involving insurance."
