Draftpriority healthPolicy N/A

Billing by nonparticipating providers for nonemergency services with advanced notice

Governs when a nonparticipating (out-of-network) provider may bill a patient for nonemergency services in Michigan after providing advance written notice and obtaining the patient's consent; affects nonparticipating providers and nonemergency patients in Michigan.

Policy Summary

Payerpriority health

PolicyBilling by nonparticipating providers for nonemergency services with advanced notice

Policy CodePolicy N/A

Change TypeNo material change (draft)

Effective Date

Next Review Date

Key ActionObtain written patient consent at least 24 hours in advance, provide a written estimate and 12-point notice, get the patient or representative's signature, and retain the signed notice for at least 7 years.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

24 hoursminimum advance notice required for written consent

12-pointminimum type size required for the notice

7 yearsminimum retention period for the signed notice

1signatures required

Billing authorization conditions

Billing authorization conditions for nonparticipating providers

Conditions that must be met for a nonparticipating provider to bill a nonemergency patient for costs not covered by the patient's health benefit plan:

ALL of the following

The nonemergency patient provides written consent at least 24 hours in advance to receive services from the nonparticipating provider.
Consent may not be obtained at the time of admission or at any time when the nonemergency patient is being prepared for surgery or any other procedure.
At the time consent is provided, the nonparticipating provider gives the nonemergency patient a written estimate of the cost of care for services to be provided.
The consent must advise the nonemergency patient that they may elect to seek care from a participating provider or contact their health benefit plan to arrange for services from a participating provider at lower cost.

Policy Summary

Payerpriority health

PolicyBilling by nonparticipating providers for nonemergency services with advanced notice

Policy CodePolicy N/A

Change TypeNo material change (draft)

Effective Date

Next Review Date

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Advance written notice & consent requirements

Documentation Required

Advance written notice & consent required for nonparticipating providers

Nonparticipating providers must obtain advance written consent and provide required notice before billing patients for services not covered by the patient’s health benefit plan. The provider must: obtain written consent at least 24 hours before the nonemergency service; not obtain consent at the time of admission or while the patient is being prepared for surgery or another procedure; provide a written estimate of the cost of care at the time consent is provided; and advise the patient they may seek care from a participating provider or contact their health benefit plan to arrange services from a participating provider at lower cost.

Consent must be obtained at least 24 hours in advance.
Consent may NOT be obtained at time of admission or while patient is being prepared for surgery/procedure.
Provider must give a written cost estimate when consent is provided.
Provider must inform patient of option to seek a participating provider or contact their health benefit plan.
Notice text must be in at least 12-point type and follow substantially the statutory form.
Provider must obtain the patient’s (or representative’s) signature on the notice acknowledging receipt, reading, and understanding.
Provider must retain a copy of the signed notice for at least 7 years.
Failure to obtain written consent may subject the provider to the requirements of Sec. 24503 and potential administrative fines by the department.

OpenPayer

Billing by nonparticipating providers for nonemergency services with advanced notice

Billing authorization conditions

Advance written notice & consent requirements

Key terms