Michigan Payment Resources



Summary of payment program


Payment

Michigan sexual assault medical forensic examinations are paid from the crime victims compensation board funding. When the patient presents to a healthcare provider or hospital within 120 hours of a sexual assault, the facility/provider is responsible for informing the patient of the medical forensic examination and the sexual assault evidence kit. They are also responsible for providing information on the payment for the examination to the survivor/patient.

Michigan Public Health law defines the sexual medical forensic examination as including all of the following:

  • collection of a medical history
  • general medical examination, including, but not limited to, the use of laboratory services and the dispensing of prescribed pharmaceutical items.
  • one or more of the following:
    • a detailed oral examination
    • a detailed anal examination
    • a detailed genital examination
  • administration of a sexual assault evidence kit, related medical procedures, laboratory and pharmacological services including emergency contraception and testing and treatment for sexually transmitted infections.

Michigan Department of Health and Human Services – Crime Victims Compensation
Michigan Crime Victim Compensation Application | Spanish | Arabic
Michigan Crime Victims Compensation Brochure | Spanish | Arabic

MI CVC Application Instructions: 
PRINT CLEARLY or TYPE all information in the application. Separate application must be completed for each victim.

  • Enclose copies of crime-related itemized medical, dental, burial or counseling bills received to date if not fully paid by insurance
  • Submit Explanation of Benefit for each date of service that was not paid in full by your insurance
  • Submit 2 or 3 paystubs paid just before the date of injury, showing gross, net and tax deductions if applying for loss of wages
  • Submit a written disability statement from your physician verifying dates you were unable to work
  • For assistance in completing this application, call the victim only toll free number 877-251-7373 or 517-373-7373


    • Return the completed application to the address:
    Crime Victim Services Commission
    Grand Tower, Suite 1113
    235 S. Grand Avenue
    PO Box 30037
    Lansing, MI 48909
    Fax: 517-373-2439

    Billing

    Michigan law says that survivors should not be billed for the direct costs of the sexual assault medical forensic exam. MCL 18.355a. The survivor’s insurance can be billed, but they are not be required to make a co-pay. If they do not want their insurance billed then a state program called SAFE Response will reimburse the healthcare provider for the examination and evidence collection. 

    A video on the SAFE Response program can be found HERE.

    SAFE – Sexual Assault Forensic Exam Claim Form | Instructions
    SAFE – CPT Code Listing
     

    Crime Victims Services Commission
    SAFE Response
    Grand Tower, Suite 1113
    PO Box 30037
    Lansing, MI  48909
    (517) 335-7233

    FAX (517) 373-2439

    Coordination with healthcare

    Examination Options

    Michigan has a website that provides information for survivors on their rights to the medical forensic examination under Michigan Law.

    Michigan Coalition to End Domestic & Sexual Violence

    Michigan has implemented a web-based sexual assault evidence kit (SAEK) tracking system, called Track-Kit™, so evidence kits can be tracked through the system. Track-Kit Sign In (for authorized users)