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No Surprises Act IDR in Michigan

Michigan: state payment standard vs. federal IDR for out-of-network claims

Michigan's surprise billing law sets a payment floor and limits arbitration to complex cases. Which out-of-network claims go to federal IDR, and how we file them.

Michigan pays by formula, arbitrates by exception

Michigan's 2020 surprise-billing legislation protects patients from balance bills for emergency and unanticipated out-of-network care and sets a payment standard — broadly the greater of the plan's median in-network rate or a Medicare-based floor. Unlike Texas or New York, Michigan's arbitration path is narrow: it's generally limited to claims involving documented medical complexity.

What that means for revenue: for state-regulated plans, most Michigan claims are worth the formula amount. The upside is on the federal side — self-funded ERISA plans, which cover most commercially insured employees, run through federal IDR where offers are argued, not calculated.

What we do for Michigan groups

  • Sort remits by plan type so federal-eligible claims aren't written off at the state payment amount
  • Run federal open negotiation and initiate on time
  • Document complexity where the state track allows a challenge
  • Batch federal disputes by payer and code to control fees

We confirm the applicable standard and process before filing.

Which process applies to your claims?

Send 90 days of out-of-network remits. We'll tell you claim by claim: federal IDR, state process, or not disputable — plus what comparable disputes have paid.

Free claims review

Related

How federal IDR works
IDR eligibility checklist
Deadline calculator
Other states

Find out what your out-of-network claims are actually worth.

Send us a sample of recent OON remits. We'll tell you which claims are IDR-eligible, what similar disputes have paid, and what we'd file. No fee unless we win you more.

Request a free eligibility review