New Changes to the No-Fault System and New Policies Coming in July (Part 3)

New Changes to the No-Fault System and New Policies Coming in July

Part 3 – Managed Care Options

                Many changes are coming under the no-fault reform that was passed last year. I previously discussed some of the changes taking place here (Part One) and (Part Two) where we discussed the new limits for personal injury and bodily injury and also discussed the coordinated coverage option.  Another one of the new options that is likely to be available within the Personal Injury Protection Benefits is a “managed care plan” option, which in short means that you treat within the insurance company’s health care network.  So is this a good idea? The short answer is almost certainly no.

First, it is important to explain what the managed care option is.  The managed care option is “an optional coverage selected by an insured at the time a policy is issued that includes, but is not limited to, the monitoring and adjudication of an injured person’s care, the use of a preferred provider program or other network, or other similar option.” – MCL 500.3181

This means by electing this option, the insurance company will be able to monitor and adjudicate, mean make their own decision, about who you treat.  In other words, the insurance company will have the right to select your doctor for you if you elect this option.  The insurance company will no doubt offer a reduction in premium if this option is selected because by doing so they will not have to cover treatment outside of their own choices for your treatment, but this comes at a great cost, in particular, that they can send you to the most conservative doctors and treatment facilities possible, and the insurance company having the relationship with those doctors means that they will have an incentive to make make an earlier evaluation that you have recovered or that the injuries do not arise out a motor vehicle accident so that the insurance company will no longer have to pay for treatment.  Moreover, if you then chose to seek a second opinion from a doctor outside of the doctors selected by the auto insurer, you auto insurance will very likely not have to cover any of those costs, and because the injuries are auto related, you other insurance may ALSO not have to cover the cost, meaning any expenses outside of the managed care plan may be your own responsibility.

In summary, the option itself gives the insurance the ability to not only monitor, but literally chose the care you receive, with little if any ability to change doctors or manage your own treatment. For these reasons, we highly recommend you avoid selecting any managed care option. 

John T. Schroder


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