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New Changes to the No-Fault System: Managed Care Options

Michigan no-fault now offers a managed care option that lets the insurer choose your doctors. Here is why we recommend avoiding it.

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Auto & Roadway Accidents

Many changes came under the no-fault reform passed in Michigan. Among the new options available within Personal Injury Protection (PIP) benefits is a “managed care plan” option, which in short means 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 helps to explain what the managed care option is. Under MCL 500.3181 it is an optional coverage selected 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 options.

This means that by electing this option, the insurance company can monitor and adjudicate, that is, make its own decisions, about who you treat with. In other words, the insurer will have the right to select your doctor for you. It will no doubt offer a premium reduction, because it will not have to cover treatment outside of its own choices, but that comes at a great cost. The insurer can send you to the most conservative doctors and facilities possible, and because it has relationships with those providers, they have an incentive to make an early evaluation that you have recovered or that your injuries did not arise from the accident, so the insurer no longer has to pay.

Moreover, if you then seek a second opinion outside of the insurer's chosen doctors, your auto insurance very likely will not cover those costs, and because the injuries are auto related, your health insurance may not cover them either. Any expenses outside of the managed care plan may become your own responsibility.

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