Michigan Court of Appeals Decides: Fee Schedule Doesn’t Apply to Accidents Before June 11, 2019
On August 25, 2022, the Michigan Court of Appeals issued its decision in Ellen M. Andary et al v. USAA Casualty Insurance Company et al., a case with significant implications for medical providers seeking payment of legacy no-fault claims.
The bottom line of the Court’s ruling: the No-Fault Fee Schedule rules that went into effect on July 1, 2021, don’t apply to patients injured in accidents that occurred before June 11, 2019, the date the amendments to the No-Fault Act were enacted. For those patients, the traditional reasonable charge limitations continue to apply.
The Court’s decision in Andary prevents automobile insurers from applying the new No-Fault Fee Schedule to patients injured in accidents before the law changed. Providers should monitor insurer denials and partial payments under the Fee Schedule to ensure compliance with the Andary decision. Because the decision is “published,” it binds automobile insurers unless and until it is overturned by the Michigan Supreme Court. We anticipate the automobile insurance industry to appeal the decision and will continue to update all developments.
If you have questions about this or any other medical reimbursement issue, please contact Joseph Gavin or any one of our provider reimbursement counsel at mjmedrecovery.com.