MI| The Michigan Department of Insurance and Financial Services (DIFS) issued Bulletin 2025-11-INS to update payment and billing guidance for no-fault automobile insurers and healthcare providers in light of recent court decisions. The bulletin clarifies that, following the Michigan Supreme Court’s Andary v USAA and the Court of Appeals’ Fremont Insurance Company v Lighthouse Outpatient Center rulings, the amended no-fault fee schedule (MCL 500.3157) does not apply to treatment for individuals injured before June 11, 2019; instead, these claims remain subject to the pre-amendment “reasonableness” standard. DIFS provides instructions for providers seeking additional reimbursement due to these rulings, emphasizes timely claim reprocessing and payment, and reminds insurers of their obligations to assist with billing and coding disputes, warning of administrative action for non-compliance.
Key points:
- The amended no-fault fee schedule does not apply to claims for individuals injured prior to June 11, 2019; instead, the pre-amendment “reasonableness” standard governs reimbursement.
- Providers seeking additional reimbursement under the new legal interpretations should contact insurers for claim reprocessing, and unresolved disputes may be brought to DIFS.
- Insurers must process claims promptly, assist providers with billing and coding issues, and may face administrative action for improper claim denials or delays.