“The key to a provider case is understanding the medicine behind the service, making sure the codes are right, and calculating what the fee schedule actually requires.”
Your right to sue the insurer directly
In 2017 the Michigan Supreme Court held in Covenant Medical Center v. State Farm that providers had no independent right to sue no-fault insurers. Providers relied on patient assignments instead. The 2019 reform reversed that: MCL 500.3112 now lets a provider make a claim and bring an action directly against the insurer for PIP benefits for treatment it provided.
Where the money is lost
| Problem | What it costs you | What we do |
|---|---|---|
| Bills denied after an insurer medical exam | The full balance from that date forward | File suit with your records and treating opinions |
| Fee-schedule miscalculation | Underpayment on every line | Recompute the amount payable under MCL 500.3157 and the DIFS bulletins (try the Michigan no-fault fee schedule calculator) |
| Claims aging past one year | The claim itself | Triage your aging report and file before balances expire |
| Priority disputes between insurers | Months of non-payment | Sue every potentially liable insurer and let the court sort priority |
| Patient settles without you | Your balance may be released | Give written notice of your claim and coordinate with patient counsel |
| Patient had no insurance | The whole bill, if the plan deadline passes | Screen the claim and apply to the Michigan Assigned Claims Plan within one year of the crash |
For uninsured patients, the Assigned Claims Plan eligibility checker has a provider mode: it screens the patient’s claim and shows the date the plan must receive the application.
What overdue bills earn
A PIP bill is overdue 30 days after the insurer receives reasonable proof of the charge. From then, MCL 500.3142 adds 12% simple interest a year. If the refusal or delay was unreasonable, the court can award attorney fees under MCL 500.3148. Interest and fees change the economics of small balances that are otherwise not worth chasing.
How an engagement works
- You start with totals: the form below or a call, with your practice, a contact and a rough unpaid balance. Once a secure transfer is set up, you send an aging report and a sample of denials or explanations of review.
- We sort balances by one-year-back exposure, insurer and denial reason, and tell you which appear supportable.
- We send demands and file suits in batches by insurer, which keeps the cost per claim down.
- We report status to you by claim and insurer.
A case in focus
Paid $64 a test. Settled at $2,500 or more
- The problem
- A provider performed detailed range-of-motion testing of the neck, back and arms and legs, producing pages of objective findings for each patient. Insurers routinely paid about $64 per test.
- What the firm did
- Filed suit on the provider’s underpaid claims. Worked with a medical coding and billing expert to confirm the codes billed were correct and to calculate what the no-fault fee schedule actually required for the test.
- The evidence that mattered
- The coding expert’s review and the fee-schedule calculation: $2,537.50 owed per test, not $64.
- Outcome
- Settlements of $2,500 or more in almost all of the provider’s cases. None went to trial.
- Keep in mind
- These are per-test amounts across a series of one provider’s claims. What is owed depends on the service, the codes billed and the fee schedule that applies.
Read Justin’s account of this case
Details that could identify the client are left out. Every matter turns on its own facts; this does not predict the result in another case. Amounts are gross, before fees, costs and liens.
What to have ready for the review
Totals are enough to start. Claim-level data comes later, through a secure transfer and after a business associate agreement.
- An aging report by insurer, with dates of service
- Recent denial letters and explanations of review
- Whether your claims run by assignment or directly under MCL 500.3112
- Who at the practice can sign a business associate agreement
- Your billing contact and the system you bill from
- Any balances already with another firm or a collector
Engagement terms
| Minimum | $3,000 in total unpaid or disputed no-fault balances. The total can be spread across many patients and insurers. |
|---|---|
| The review | Free. A written summary by insurer and denial reason before you sign anything. |
| Fee | A contingency fee: a percentage of what is collected, set in a written engagement agreement before any demand or suit. No hourly billing, and no fee if nothing is collected. |
| Case costs | Filing fees and other case costs are advanced by the firm and repaid only from recoveries. |
| Interest and fee awards | 12% statutory interest on overdue bills is part of the recovery. Attorney fees an insurer is ordered to pay under MCL 500.3148 are credited toward the firm’s fee, so a fee award lowers what you pay. |
| Reporting | A written status report every month, by insurer and claim, and one named contact at the firm. See a sample report. |
| Patient data | No patient information until a business associate agreement is signed and a secure transfer is set up. |
| Your patients’ cases | We coordinate with a patient’s own attorney so a patient settlement doesn’t release your balance by accident. |
| Ending it | Either side may end the engagement with 30 days’ written notice. Suits already filed continue under the agreement unless both sides agree otherwise. |
Aging is the variable that changes every month. The one-year-back rule bars recovery of charges incurred more than a year before suit unless a pending claim paused the clock. How the rule works for providers.
Every provider topic
- The fee scheduleHow MCL 500.3157 caps reimbursement and where insurers get it wrong.
- The one-year-back ruleKeeping aging balances collectable.
- Direct claims and assignmentsMCL 500.3112 claims versus patient assignments.
- Utilization review appealsAppealing overutilization denials to DIFS.
- Rescission suits that name providersWhat to do when an insurer sues you to avoid paying.
- Home care and attendant care agenciesRates, hours and the 2026 bulletin.
- Surgeons and surgery centersHigh-balance claims, IMEs and fee-schedule disputes.
- Interest and attorney fees12% interest and fee shifting on overdue bills.
- Reasonable proof and documentationWhat makes a bill payable and starts the 30-day clock.
- Priority disputes for providersGetting paid when insurers point at each other.
- Provider intake portalStart a free claims review with totals; the aging report follows through a secure transfer.
Questions people ask us
Do we need a patient assignment to sue?
Not for treatment after June 11, 2019, when the Legislature gave providers a direct cause of action in MCL 500.3112. Assignments can still be useful, for example when a claim spans the reform date, and we review your intake paperwork for both.
Does suing the insurer interfere with our patient’s own case?
It can if nobody coordinates. A patient’s settlement or release can affect a provider’s claim. We coordinate with the patient’s attorney so your balance is protected and the patient’s case is not disrupted.
How are your fees charged?
Provider collections are handled on a contingency fee, so we are paid from what we recover. The percentage is set out in a written engagement agreement before we file anything.
An insurer named us as a defendant in a rescission lawsuit. What should we do?
Respond on time and do not assume the case only concerns the patient. Insurers often name providers to avoid paying outstanding bills. Send us the complaint the day it arrives.
