01/17/2024

DIFS Reminds Michigan's Health Insurers They May Not Exclude Coverage for Cancer Therapies

To help ensure that life-saving cancer treatments are accessible and affordable for Michiganders, Michigan Department of Insurance and Financial Services (DIFS) Director Anita Fox took action to remind Michigan’s health insurers that they may not exclude coverage for cancer therapies, including genetic therapies or immunotherapies, that meet the coverage requirements listed in state law. 

“The Michigan Department of Insurance and Financial Services is committed to protecting Michiganders by ensuring that health insurers are following all state and federal laws and regulations,” said Director Fox. “Michiganders should also know that they have the right to appeal and file a complaint with DIFS if they believe their health insurer is improperly denying or limiting coverage for health care services, including cancer treatment. More information about this process is available on the DIFS health insurance website or by calling the DIFS Call Center at 877-999-6442, Monday through Friday from 8 a.m. to 5 p.m.” 

As affirmed in a newly issued DIFS bulletin, Michigan law prohibits health insurers from denying coverage for cancer treatments, including genetic and immunotherapies when certain criteria are met, including that the treatment is ordered for a specific cancer and the treatment is approved by the United States Food and Drug Administration for cancer therapy, even if it is not approved for the specific cancer being treated.  

Under Michigan’s Patient's Right to Independent Review Act (PRIRA), patients have the right to appeal, first to their insurer and then to DIFS, if they disagree with a denied health insurance claim. If DIFS finds that an insurer that has improperly denied coverage, the insurer will be ordered to cover the denied services. In addition, the insurer may be referred for enforcement action or a market conduct examination, which may result in penalties or other regulatory actions under the Michigan Insurance Code. Michiganders with self-funded group health plans offered by some large employers should contact their insurer or employer to learn how to appeal an insurance denial. 

Michiganders who still need health insurance for 2024 can take advantage of the Health Insurance Marketplace open enrollment, which continues until January 16, with coverage starting on February 1. You may qualify for savings, and many Michiganders are able to find a health plan for less than $10 per month. More information is available on the DIFS health insurance website. In addition, free local enrollment help is available at LocalHelp.HealthCare.gov.