In 2020, both Congress and the Massachusetts legislature passed laws related to surprise or out-of-network billing and related requirements for notice and disclosure for patients regarding network status and price transparency. The federal “No Surprises Act”, establishes a comprehensive statutory framework, including a ban on surprise billing, creation of an independent dispute resolution process, and patient notice and disclosure provisions. Provisions contained in the Massachusetts Patients First Act (Section 25 of Chapter 260 of the Acts of 2020), as detailed in the Massachusetts Department of Public Health (MDPH) bulletin below, similarly impose provider responsibilities for patient notice and disclosure regarding network status and price transparency.
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are
protected from surprise billing or balance billing.
When you see a doctor or other health care provider, you may owe certain out of pocket cost-sharing, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see an out-of-network provider or visit a health care facility that is out-of-network.
“Out-of-network” means providers and facilities that haven’t signed a contract with your insurance company to provide services. Out-of network providers may be allowed to bill you for the difference between what the insurance plan pays and the full amount the provider charged for a service. This is called “balance billing.”
This amount is likely more than in-network costs for the same service and does not count toward your deductible or annual out-of-pocket maximum. “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provide.
You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your insurance plans network. If you do decide to receive out-of-network care with Boston Sports & Biologics we will ask you to sign a waiver.
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
For specific information on your state laws, please contact the insurance commissioner for the state in which you received your care.
The federal phone number for information and complaints is: 1-800-985-3059. Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
The Massachusetts Division of Insurance, Consumer Service Unit at 617-521-7794.
More information here