Massachusetts Balance Billing Law

Overview

Massachusetts Chapter 260 prohibits balance billing for emergency services, unplanned out-of-network care at in-network facilities, and ground ambulances. This is the broadest protection among states. Providers cannot charge patients the difference between their fee and the insurer's payment for covered services. The Massachusetts Health Policy Commission oversees disputes.

Key Requirements

1. Patients at in-network facilities receiving emergency care from OON providers are protected from balance bills.
2. Unplanned OON services at in-network facilities must be billed at in-network rates.
3. Ground ambulance providers are protected from balance billing for covered services.
4. Patients must receive written notice of balance billing rights within 30 days of the bill.
5. Disputes are resolved through the Massachusetts Health Policy Commission.

Penalties and Enforcement

Providers who balance bill in violation of Chapter 260 face penalties from the MA Health Policy Commission and Division of Insurance. Insurers who fail to honor Commission decisions face fines and license discipline. The Commission investigates complaints and compels compliance through enforcement actions.

Appeals and Exceptions

Balance billing protections do not apply to elective out-of-network services chosen by the patient. Emergencies and unplanned care at in-network facilities are protected. Ground ambulance protection is unique to Massachusetts. Federal NSA standards provide additional coverage in some cases.

Interaction with Federal Law

Massachusetts Chapter 260 exceeds federal No Surprises Act protections. Both cover emergency services. Massachusetts extends to planned OON services at in-network facilities and ground ambulances. The state law is more protective and applies first. When state and federal law conflict, Massachusetts protections govern.

Common Questions