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Massachusetts Legislation Takes a Stand on Surprise Medical Billing

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The National Law Review writes of an omnibus healthcare law which was signed on January 1 2021 entitled “An Act promoting a resilient health care system that puts patients first,” which is aimed at addressing pressing healthcare issues in Massachusetts, many of which have been exacerbated by the COVID-19 pandemic.

The act addresses a wide variety of healthcare issues, such as surprise billing, advanced practitioner scope of practice, telehealth, mental health parity and healthcare accessibility. In relation to surprise billing, the act:

  • Requires providers to disclose their out-of-network status to patients prior to admission
  • Requires providers, upon patient request, to disclose the amount to be charged for admission, a procedure, or service, including the amount for any healthcare services rendered by an out-of-network provider and any facility fees
  • Requires providers making referrals to notify patients if the provider to whom the patient is referred is out-of-network for the patient
  • Prohibits providers from billing an insured patient for healthcare services in excess of the applicable coinsurance, copayment, or deductible that would be imposed for such services if they were rendered by a participating provider
  • Directs the Secretary of the Executive Office of Health and Human Services (EOHHS) to work with the Health Policy Commission (HPC), Center for Health Information and Analytics (CHIA), and Division of Insurance to recommend, among other things, a default rate for out-of-network billing by September 2021.

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