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This version of the form is not currently in use and is provided for reference only. Download this version of
Form FIS2370
for the current year.
Form FIS2370 Surprise Medical Billing Response to Calculation Review Request - Michigan
What Is Form FIS2370?
This is a legal form that was released by the Michigan Department of Insurance and Financial Services - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is FIS2370?
A: FIS2370 is a response to a Calculation Review Request for Surprise Medical Billing.
Q: What is Surprise Medical Billing?
A: Surprise Medical Billing refers to unexpected medical bills that patients receive after receiving care from out-of-network providers.
Q: What is a Calculation Review Request?
A: A Calculation Review Request is a formal request made by a patient or their representative to review the calculation of a medical bill.
Q: Why is FIS2370 sent to Michigan?
A: FIS2370 is sent to Michigan as a response to a Calculation Review Request made by a patient or their representative in Michigan.
Q: What does FIS2370 contain?
A: FIS2370 contains the response to the Calculation Review Request, including details of the calculation review and any changes made to the medical bill.
Q: What should I do if I receive FIS2370?
A: If you receive FIS2370, carefully review the response and compare it with the original Calculation Review Request to ensure that all concerns have been addressed.
Q: Can I dispute the response in FIS2370?
A: Yes, if you are not satisfied with the response in FIS2370, you have the right to further dispute the medical bill or seek additional resolution options.
Q: Who can help me with further dispute or resolution options?
A: You can reach out to your health insurance provider or seek assistance from a healthcare advocate or consumer protection agency for help with further dispute or resolution options.
Q: How can I prevent Surprise Medical Billing?
A: To prevent Surprise Medical Billing, it is important to verify that all healthcare providers involved in your care are in-network and covered by your health insurance plan.
Form Details:
- Released on July 1, 2021;
- The latest edition provided by the Michigan Department of Insurance and Financial Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form FIS2370 by clicking the link below or browse more documents and templates provided by the Michigan Department of Insurance and Financial Services.
Download Form FIS2370 Surprise Medical Billing Response to Calculation Review Request - Michigan
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