News on No-Fault: DIFS Bulletin addressing reimbursement limitations to certain products, services and accommodations

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On October 11, 2021, the Director of the Department of Insurance and Financial Services (“DIFS”) issued Bulletin 2021-38-INS addressing the applicability of the reimbursement limitations set forth in MCL 500.3157 to certain products, services and accommodations that constitute “[a]llowable expenses” under MCL 500.3107(1)(a).  Specifically, in the Bulletin, DIFS opined that “[p]roducts, services, and accommodations that are not provided by physicians, hospitals, clinics, or other like persons . . .” are not subject to the reimbursement limitations set forth in MCL 500.3157.   In the Bulletin, DIFS also expressed its view that MCL 500.3157 “governs the amount payable to any persons providing attendant care” services to auto accident survivors.

The Bulletin provided examples of several types of products, services, and accommodations that are, in DIFS’ view, exempt from the “fee caps” in MCL 500.3157, including, but not limited to, the following:

  • Services related to guardianship or conservatorship;
  • Vehicle modifications;
  • Home modifications;
  • Computer equipment and supplies;
  • Generators;
  • Non-emergency medical transportation;
  • Non-prescription drugs;
  • Over-the-counter medical supplies; and
  • Certain case management services

Notably, the list of exempted products, services, and accommodations set forth in the Bulletin is not exhaustive, as DIFS itself acknowledged.  Instead, according to DIFS, the proper inquiry for determining whether a particular product, service or accommodation is subject to the reimbursement limitations set forth in MCL 500.3157 is whether it was “provided by physicians, hospitals, clinics, or other like persons.”

Moreover, in the Bulletin, DIFS explicitly directed no-fault insurers who have applied the reimbursement limitations in MCL 500.3157 to products, services, and accommodations that are exempt (including those listed above) to “re-process” the claim immediately, applying only the “reasonable[ness]” requirement set forth in MCL 500.3107(1)(a).  Further, DIFS instructed providers whose bills have been processed improperly to contact the no-fault insurer at issue to request reconsideration.

In short, DIFS’ Bulletin 2021-38-INS may be used by providers other than “physicians, hospitals, clinics, or other like persons” to assert that the “fee caps” set forth in MCL 500.3157 should not be applied to limit reimbursement by no-fault insurers for the products, services, or accommodations that those providers  render to auto accident survivors.

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