Here’s What is in the Massachusetts Balance Billing Law

Understanding the Provisions of the Massachusetts Balance Billing Law

This year, Massachusetts enacted another consumer protection law that directly addresses balance billing among the state’s three major insurers. Previously, the Commonwealth only had laws providing partial protection against surprise billing. This law, in conjunction with the No Surprises Act, will significantly impact the workflow and billing processes of providers across the Commonwealth. 

The new state law works in tandem with the federal No Surprises Act. The federal law specifically targets surprise billing from emergency treatment. The new Massachusetts state law targets surprise billing in non-emergency medical scenarios. The state law doesn’t go as far as the No Surprises Act because it only requires that a healthcare provider states whether or not they participate in their patient’s health plan before carrying out a non-emergency procedure.   

There are some other key provisions that are similar to the mandates in the No Surprises Act.  

According to an article published by WickedLocal, the state law mandates the following;  

  • Providers must disclose if they are out-of-network prior to the patient’s admission
      
  • Upon request, providers must share the amount a patient will be charged for admission, treatment, or a service, including services performed by an out-of-network provider.
      
  • Providers are required to notify patients if they are being referred to an out-of-network provider
      
  • Providers are prohibited from billing insured patients in excess of the typical, applicable co-insurance, co-payment, or deductible that they would have been charged had the services been performed by an in-network provider  

Healthcare providers, insurers, medical facilities and offices, and patients are all impacted by this new state law. Violations of the law carry significant financial penalties, specifically a $2500 penalty per violation. The law went into effect on January 1, 2022 and will be enforced. Massachusetts-based providers and practices should continue to prepare as the new law is rolled out in the early part of this year. A comprehensive review of your billing and documentation practices is a good first step to take. The most important goal is to ensure that you can provide your patients with the appropriate documentation of their treatment and estimated costs. We will fully review all the best steps you can take to prepare in another blog post in this series. 

In the meantime, if you have questions on how either the No Surprises Act or the Massachusetts Balance Billing law will affect you, please contact us. 

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