HOUSE BILL NO. 6251
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3157c.
the people of the state of michigan enact:
Sec. 3157c. (1) Subject to the exceptions and limitations in this chapter except as expressed in this section, and subject to chapter 31A, a health care provider listed in section 3157 that lawfully renders treatment to an injured person for an accidental bodily injury covered by personal protection insurance may charge an amount that was established to be payment in full on June 10, 2019 for the specific type of treatment under either of the following:
(a) A contract between the health care provider and the insurer responsible for payment, or between the health care provider and a parent, subsidiary, or affiliate of that insurer that was in force on June 10, 2019.
(b) A contract between the health care provider and a preferred provider organization that was in force on June 10, 2019 and had been in force for at least 1 year, if the insurer responsible for payment or a parent, subsidiary, or affiliate of that insurer participated in or was a member or customer of the preferred provider organization on June 10, 2019 that would have allowed the insurer, or a parent, subsidiary, or affiliate of that insurer, to pay the established rate as payment in full for the treatment or training, and the insurer, or a parent, subsidiary, or affiliate of the insurer, had issued at least 1 payment to the health care provider before June 10, 2019 with reference to a rate established by the preferred provider organization.
(2) An amount of charges applicable under subsection (1) satisfies the reasonable charge requirement of section 3107(1)(a) and is not subject to any limitations of section 3157.
(3) For any personal protection insurance benefits payable under section 3107(1)(a) that are subject to the charge limitations of subsection (1) or subject to any reimbursement limitations of section 3157, if the claim for benefits has become overdue under section 3142 and over 120 days have elapsed since the insurer responsible for benefits received written notice of the injury given as required under section 3145(4), the claimant is additionally entitled to payment of a penalty from the insurer responsible for payment of the benefits equal to 2 times the overdue amount.
(4) The claimant entitled to the payment of any penalty under subsection (3) is the health care provider who rendered or provided the treatment, but the penalty may instead be recovered by the injured person in any of the following circumstances:
(a) The health care provider did not submit any claims for unpaid benefits on the provider's own behalf to the insurer responsible for the payment of the benefits.
(b) The health care provider has provided irrevocable written permission to the injured person or the injured person's attorney for the unpaid benefits and the penalty to be claimed as part of an action that was or is brought by the injured person.
(c) The health care provider has not brought a timely action for unpaid benefits under section 3145 and the time to bring such an action has elapsed.
(5) If there is doubt about the proper person to receive payment or disputes after the insurer has issued payment and if subsection (4)(b) or (c) applies, any interested person may apply to the circuit court for an appropriate order in the same manner as set forth in section 3112.
(6) In an action to recover the payment of unpaid benefits, the penalty described in subsection (3) must not be considered in determining the jurisdictional amount.
(7) If a penalty becomes payable under subsection (3), and benefits payable under section 3107(1)(a) are subsequently exhausted under an applicable limit under section 3107c(1)(a), (b), or (c), or 3172(7), the insurer may not raise an exhaustion of benefits defense as to any portion of the unpaid benefits or the penalty under subsection (3).
(8) As used in this section:
(a) "Insurer" includes the Michigan automobile insurance placement facility or an insurer assigned by the Michigan automobile insurance placement facility under section 3173a(3).
(b) "Treatment" means that term as defined in section 3157.