Physician fee schedule changes July 1, 2017 for patients with individual health plans


The individual market created by the Affordable Care Act continues to pose significant challenges for health plans here in Michigan and nationally. The ACA exchange population has been much sicker and more costly than anyone anticipated, and we continue to see individuals abuse the system and purchase coverage for urgent issues and then drop coverage after receiving services. These challenges add complexity to an already volatile health care industry where pharmacy costs continue to escalate at unsustainable rates while our population grows older and increasingly unhealthy. This is forcing everyone to make difficult decisions in order to be able to continue to serve this market.

In an effort to address these unsustainable costs, we have to adjust provider pricing so we can continue to offer ACA plans beyond 2019. 

See the new MyPrioritySM plan fee schedule (you must be logged in).

Need help identifying your patients with ACA health plans?


If you have questions about this fee schedule change, contact your Provider Performance Specialist (PPS) or call the Provider Helpline at 800.942.4765.