DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES  
INSURANCE  
SURPRISE MEDICAL BILLING  
Filed with the secretary of state on June 24, 2021  
These rules take effect immediately upon filing with the secretary of state unless adopted  
under section 33, 44, or 45a(6) of the administrative procedures act of 1969, 1969 PA 306,  
MCL 24.233, 24.244, or 24.245a. Rules adopted under these sections become effective 7  
days after filing with the secretary of state.  
(By authority conferred on the director of the department of insurance and financial  
services by section 24517 of the public health code, 1978 PA 368, MCL 333.24517)  
R 500.241, R 500.242, R 500.243, R 500.244, and R 500.245 are added to the Michigan  
Administrative Code, as follows:  
R 500.241 Definitions.  
Rule 1. (1) As used in these rules:  
(a) “Act” means the public health code, 1978 PA 368, MCL 333.1101 to 333.25211.  
(b) “Median amount” means the median amount negotiated by the carrier for the region  
and provider specialty, excluding any in-network coinsurance, copayments, or deductibles.  
The carrier shall determine the region and provider specialty.  
(2) A term defined in the act for the purposes of article 18 of the act, MCL 333.24501 to  
333.24517, has the same meaning when used in these rules.  
R 500.242 Scope and applicability.  
Rule 2. These rules do the following:  
(a) Establish procedures for the department to review and resolve requests for calculation  
review submitted pursuant to section 24510 of the act, MCL 333.24510.  
(b) Establish procedures for approving arbitrators to provide binding arbitration pursuant  
to section 24511 of the act, MCL 333.24511.  
R 500.243 Requests for calculation review.  
Rule 3. (1) A nonparticipating provider must make a request for a review of the  
calculation described in section 24510(1) of the act, MCL 333.24510, on a form provided  
by the department.  
(2) In response to a request from a nonparticipating provider for a calculation review  
under section 24510 of the act, MCL 333.24510, the department shall do the following  
within 14 days of the date of the request:  
(a) Notify the carrier of the request for a calculation review.  
(b) Request data on the carrier’s median amount or any documents, materials, or other  
information the department believes is necessary to assist in reviewing the calculation  
described in section 24510(1) of the act, MCL 333.24510.  
April 22, 2021  
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(3) A carrier must respond within 14 days of the date of the department’s request under  
subrule (2)(b) of this rule. If the information provided is incomplete, the department may,  
at its discretion, request additional information, or issue a determination based solely on  
the information provided as of the date on which the carrier’s response was due. If the  
department makes 1 or more requests for additional information, the carrier must respond  
within 14 days of the date of the department’s request.  
(4) The department shall issue a determination resolving the request for a calculation  
review no later than 14 days after the carrier submits a timely and complete response under  
subrule (3) of this rule or after the expiration of the time period within which the carrier  
was required to respond, including any extensions provided following the department’s  
request for additional information under subrule (3) of this rule.  
R 500.244 Median amount; access to database.  
Rule 4. (1) Subject to subrule (3) of this rule, a carrier may satisfy the requirement under  
R 500.243 by providing the department with access to a database that contains all of the  
carrier’s median amounts. The database must meet all of the following requirements:  
(a) Be updated no less frequently than quarterly.  
(b) Be searchable by region, provider specialty, and health care service.  
(c) Include negotiated rates for all health care services covered by the carrier.  
(d) Be continuously accessible to the department.  
(2) For the purposes of conducting a calculation review under section 24510 of the act,  
MCL 333.24510, the department may, at its discretion, consult any external database  
described under section 24510(2) of the act, MCL 333.24510, without regard to whether a  
carrier made the database accessible to the department or whether the database otherwise  
meets the requirements under subrule (1) of this rule.  
(3) A carrier’s provision of access to a database under this rule does not preclude the  
department from requesting any documents, materials, or other information the department  
believes is necessary to assist in reviewing the calculation described in section 24510(1) of  
the act, MCL 333.24510.  
R 500.245 Approval of arbitrators.  
Rule 5. (1) The department shall create and maintain a list of arbitrators trained by the  
American Arbitration Association or American Health Lawyers Association and approved  
by the director. This list must be updated no less frequently than annually and must be  
posted on the department’s website.  
(2) Arbitrators seeking to be included in the list under subrule (1) of this rule must apply  
on a form prescribed by the department.  
(3) The department shall approve or disapprove an application no later than 60 days after  
the date of receipt of the application. Applicants whose application has been disapproved  
may reapply at any time.  
(4) If approved for inclusion in the list under subrule (1) of this rule, arbitrators must  
annually provide to the department, on a form prescribed by the department, an attestation  
acknowledging that the information provided to the department in the arbitrator’s  
application under subrule (2) of this rule remains complete and accurate.  
(5) Arbitrators included on the department’s list under subrule (1) of this rule must notify  
the department of any changes to the information contained in the arbitrator’s application  
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under subrule (2) of this rule within 30 days of the change. An arbitrator’s failure to inform  
the department of these changes may result in revocation of the arbitrator’s approval and  
removal from the list under subrule (1) of this rule.  
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