Detroit Mayor Mike Duggan’s “D-Insurance” proposal is all over the news. But the proposal could leave doctors and other medical providers out of luck and out of work.
Mayor Duggan’s “D-Insurance” proposal cuts benefits for Detroit residents who opt into the plan without promising any premium drops. The plan also makes life far more difficult for medical providers in Detroit and across the state.
Closed D-Insurance Provider Networks
“Qualified No Fault Policies” under D-Insurance can require Detroiters to get treatment from closed provider networks. If an injured person goes out of network, they can lose coverage. This leaves medical providers with a tough choice – join the closed provider network or take a chance that their patients’ bills will not be paid.
Under Mayor Duggan’s proposal, insurance companies can require the right to pre-authorize products, treatments, services, and therapies, and only grant coverage if the service is “medically necessary.” This puts the insurance company between doctors and their patients, with veto power over the doctor’s medical advice. If the treatment facility provides services without pre-authorization, it can forget receiving compensation. Any claim will be null and void.
Questions Over “Critical Care”
The D-Insurance proposal creates separate policy buckets for “critical care” and non-critical care. But it does not clearly define what is covered in the higher “critical care” benefits. The higher benefit applies only to life saving and disability saving treatment provided before the patient stabilizes.
Given the insurance companies’ track records with questioning “reasonable and necessary” treatments under the No Fault Act, medical providers can expect D-Insurance providers to second guess all of their decisions regarding critical care and when a patient is considered “stabilized.” This will lead to lengthy and expensive litigation to determine whether the doctor can be compensated.
No Direct Right to Sue
When it comes to that litigation, under the Michigan No-Fault Act, doctors and medical treatment providers have the right to sue insurance providers directly for treatments provided to their patients. Instead, they will have to rely on their patients to file the lawsuit and then collect from any settlement or trial award using a lien.
The non-critical care portion of a D-Insurance policy covers only $25,000 in benefits, including all medical treatment, replacement services, lost wages, and attendant care. That means that all of a Detroit resident’s medical providers will have to fight over the limited policy coverage. Since they can’t act on their own, every provider will be paid out of the settlement, and have to settle for a substantially reduced payment.
Do you think D-Insurance is fair for doctors? Should they be able to sue directly or work with their patients? Add your voice in the comments below.