A recent study found that found that 22 percent of the time, patients who went to a hospital covered by their plan still received a bill from a doctor who was out of network. The average such bill cost more than $900, and the highest was for more than $19,000. Patients should never be subject to surprise bills, whether in an emergency situation or otherwise. Several states have passed legislation aimed at tackling this bait-and-switch problem, including New York, Florida and California. This legislation ends surprise billing by (1) requiring out-of-network providers in emergency care situations to work with the patient’s insurer (who is statutorily required to cover emergency services) and not balance bill a patient for additional costs, (2) requiring out-of-network providers at a participating/in-network facility to work with the patient’s insurer (who is already required to cover these services) and not balance bill a patient for additional costs, and (3) requiring out-of-network providers to perform an eligibility check and obtain appropriate consent before performing services on a patient.
This bill increases transparency and requirements around the amount of risk-based capital (RBC) held by carriers. Currently, the surplus of Massachusetts insurers is higher than both the minimum statutory standards and the minimum RBC standards that the state’s Division of Insurance (DOI) uses for monitoring purposes. All of the insurers exceed the 200 percent Company Action RBC level, some by a factor of two or three. Under this bill, carriers exceeding 600 percent would be listed publicly on the DOI website and would be required to submit testimony to the DOI on the continued need for additional surplus as well as how the carrier will use the additional surplus to reduce the cost of patient premiums.
This legislation adds a registered nurse who is licensed to practice in Massachusetts to the board of the Health Policy Commission. The governor would be responsible for appointing an eligible nurse. It also adds a public health expert with experience in implementing strategies to eliminate health care disparities to the board. The attorney general would be responsible for appointing an eligible public health expert.