Attorneys in Michigan For Medical Providers

Yes, since the 2019 no-fault reform. MCL 500.3112 gives providers a direct cause of action against no-fault insurers for services they rendered. Before the reform, the Michigan Supreme Court's Covenant v. State Farm decision (2017) had eliminated that right and required providers to work through the injured patient. The 2019 statutory fix restored it, so providers no longer depend on the patient's cooperation to pursue payment, though coordinating with the patient's PIP claim often strengthens both. 

Michigan's no-fault law (MCL 500.3145) limits recovery to expenses incurred within one year before the lawsuit is filed. Every month an unpaid claim sits in your receivables, you're losing recoverable value. Providers who wait a year or more to address a pattern of denials often lose the right to recover the older bills entirely. If you're seeing consistent denials or underpayments, this is the deadline that makes acting quickly essential. 

Denials and underpayments are challengeable, but the path depends on why the carrier denied. Common denial types include disputes over reasonableness, medical necessity, fee schedule calculations, IME findings, priority between insurers, and coverage exclusions. Each has its own legal standard and options for challenge. We review the denial letter, the underlying claim, and the carrier's history, then decide whether to negotiate, arbitrate, or litigate. Interest and attorney fees are recoverable under Michigan law when a carrier's denial is unreasonable. 

The 2019 reform introduced a fee schedule that caps what no-fault insurers pay for many services. Caps vary by service type, provider category, and whether Medicare has a comparable code. For services with a Medicare code, the current rate is a percentage of the Medicare rate that adjusts down over time. For services without a Medicare code, the calculation uses a different methodology. The rates are lower than what many providers historically charged, and the calculations are frequently disputed. If a carrier is applying the fee schedule incorrectly or refusing to explain a reduction, that's a common basis for challenge. Read more in our post on how no-fault reform affects healthcare providers. 

Balance billing is when a provider bills the patient for the difference between what the no-fault carrier paid and what the provider charged. Under Michigan law, a provider can sometimes pursue a balance bill directly against the patient, which then triggers the auto insurer's obligation to defend and pay for the patient. The Michigan Court of Appeals in Auto Owners v. Compass Healthcare confirmed that the one-year-back rule applies to balance bills, so the same deadline pressure applies. Whether balance billing is the right strategy depends on the specifics of your case. 

We represent a range of providers including hospitals, surgical centers, physicians, chiropractors, physical therapists, imaging and diagnostic centers, home health agencies, transportation companies, and case managers. If your practice treats patients injured in motor vehicle accidents and bills a no-fault carrier for those services, we can likely help. Reach out for a free consultation. 

Provider representation is typically handled on a contingency or hybrid fee basis, so fees come from the recovery rather than upfront. Michigan's no-fault law also allows recovery of interest and attorney fees from the insurer when a denial is unreasonable, which often means the provider's net recovery isn't reduced by legal costs. The exact structure depends on the portfolio size, case complexity, and volume of claims involved. We'll walk through the fee structure at your consultation before you commit to anything.