Massachusetts Surprise Billing Law

Overview

Massachusetts Chapter 260 (effective 1/1/2021) shields patients from surprise bills for emergency services, unplanned out-of-network care at in-network facilities, and ground ambulances. This is the broadest state protection. Providers cannot charge patients the difference between their fees and insurer payments. The Massachusetts Health Policy Commission handles disputes.

Key Requirements

1. Patients receiving emergency services at any facility are protected from balance bills regardless of provider in-network status.
2. Patients receiving unplanned OON services at in-network facilities are covered at in-network rates.
3. Ground ambulance services are protected from balance billing.
4. Providers must disclose balance billing rights within 30 days of the bill.
5. Facilities must include EOB and fee schedule information with patient bills.

Penalties and Enforcement

Providers violating Chapter 260 face administrative fines and license discipline. Insurers who fail to honor Commission decisions face penalties and sanctions. The MA Health Policy Commission investigates complaints and compels payment. Repeat violators face escalating penalties and potential license revocation.

Appeals and Exceptions

Surprise billing protections apply to emergencies and unplanned services. Elective out-of-network care is not protected. Ground ambulance protection is unique to Massachusetts. Federal NSA rules provide overlapping coverage. Commission decisions are binding.

Interaction with Federal Law

Massachusetts Chapter 260 exceeds federal No Surprises Act protections. Both cover emergency services. Massachusetts extends to non-emergency OON services at in-network facilities and ground ambulances. Patients receive the benefit of the more protective state standard. State law applies first when there is conflict.

Common Questions