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Insurance Commissioner Bulletin 92-03; (10/23/1992; RB #1583)


Commissioner David J. Dykehouse
Link to Opinion alt

Providers Entitled to Charge Reasonable Amount for Services [§3157] 
Balance Billing Patients for Amounts not Covered by Other Insurance [§3157]  

Not Applicable   

On October 23,1992, Commissioner Dykehouse issued an "interpretative statement" stressing the responsibilities of no-fault insurers who deny payment of certain medical expenses under §3107(l)(a) on the basis that the providers charges are not "reasonable." Some of these cases have precipitated a dispute between the insurer and the provider and the provider has billed the patient for the disputed amount and vigorously pursued collection against the patient Commissioner Dykehouse stated, "the purpose of this Bulletin is to remind no-fault insurers that they are required to provide insureds and claimants with complete protection from economic loss for benefits provided under personal protection insurance." The Commissioner went on to say that when a dispute arises, a no-fault insurer must adhere to the following procedures:

"First, the insurance company must assume its statutory responsibility for complete protection of the insured. To do so, the insurer should notify the provider that the insurer is responsible for paying any reasonable charges, not the insured or claimant. Second, the insurer must also assure the policyholder or claimant of its responsibility. Insureds and claimants should be given directions on how to handle any bills or collection notices they receive. Third, the insurer should notify collection agencies and credit reporting agencies to disregard medical providers' claims against the insured for services covered under personal injury protection benefits. And finally, health care providers should be warned that the insurer will defend the insured or claimant against any attempt to collect, and may also consider any other appropriate action to prevent its policyholder from being pursued for collection.

A dispute between a medical provider and the insurer as to the reasonableness of the charge for services does not void the insurer's obligation to its insureds and claimants to pay the amount ultimately determined to be reasonable. The insurer also has an obligation to protect its insureds and claimants from any consequences of such a dispute."  

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