State health officials tout ‘surprise billing’ law | News

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BOSTON — State public health officials are touting a new law set to go into effect this year aimed at preventing “surprise” billing by health care providers.

Gov. Charlie Baker signed the law in 2021 requiring that health care providers tell patients how much they will pay for planned hospital stays, medical procedures, healthcare services and referrals — based on their individual health plans.

The new requirements, which were originally set to go into effect Jan. 1, were delayed amid concerns that they conflict with pending new federal protections.

The Baker administration has set a new date of July 31 to implement the law, and wants to make patients and providers aware of their rights and obligations.

In a letter to providers, the state Department of Public Health explains that health care practitioners covered by the law will be required to notify prospective patients if they participate in their health plan when scheduling an appointment, procedure or non-emergency medical service.

“This notice must be given at the time of an admission, procedure or service scheduled for a condition it is not an emergency medical condition or upon request by the patient,” the agency wrote.

Providers that violate the new rules face fines of up to $2,500 per violation, but DPH says it won’t initially be issuing fines, to give them time to come in to compliance.

The state agency posted a similar notice for patients, advising them of their rights under the new law.

“You have the right to know how much your health insurance plan will pay for that hospital stay, medical procedure or health care service,” DPH officials wrote. “You also have the right to know what if any facility fees you will be charged for that hospital stay, medical procedure or health care service.”

If a provider is unable to give a specific quote in advance of the treatment, the law requires them to provide an estimate of the likely charges and any facility fees.

Medical professionals covered by the new requirements include primary care physicians, specialists, dentists, nurses, social workers, psychologists and chiropractors. The requirements also include hospitals, pharmacies, community health centers and nursing homes.

To be sure, the new DPH rules might have to be revised after Biden administration officials finalize regulations for a new law that provides federal protections against surprise medical billing.

The No Surprises Act, which was signed by President Donald Trump in 2020, will require private health plans to cover out-of-network claims and apply in-network cost sharing and prohibits doctors, hospitals and other providers from billing patients more than the in-network cost sharing amount for surprise medical bills.

Unlike the state law, the federal No Surprises Act would apply to most emergency services, including those provided in emergency rooms and urgent care centers.

But the new law, which is set to go into effect this year, has been challenged in federal court by the American Hospital Association, American Medical Association and other groups that argue that provisions of the act dealing with resolving billing disputes will benefit private insurers and compromise care for patients.

So-called ‘surprise’ medical bills occur when insured patients inadvertently receive care from out-of-network hospitals, doctors or other providers they didn’t choose. Some patients have reported getting hit with hospital bills for hundreds of thousands of dollars in out-of-pocket expenses, not covered by insurance.

A recent study by the Kaiser Family Foundation found that surprise billing happens in about one in every five hospital visits.

“We are pleased that action has been taken at both at the federal and state levels to address surprise out-of-network billing, which can burden consumers with high bills and medical debt they had no way of avoiding,” said Alyssa Vangeli, co-director of policy and government relations at Health Care For All, a nonprofit advocacy group.

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at cwade@northofboston.com.

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