Balance Billing Laws in Massachusetts
Your medical billing rights and protections in Massachusetts.
Massachusetts enacted Chapter 224 of the Acts of 2012 and M.G.L. c. 176O, § 24, providing some of the earliest and most comprehensive surprise billing protections in the nation. The law prohibits balance billing in emergencies and for non-emergency care at in-network facilities, and requires insurers and providers to resolve payment disputes directly without involving patients.
Key Protections in Massachusetts
Emergency services: Balance billing is prohibited for emergency services under MGL c. 176O; patients pay only in-network cost-sharing
Out-of-network at in-network facility: Patients at in-network hospitals receiving care from out-of-network providers are protected from balance billing
Dispute resolution: Division of Insurance oversees an arbitration process for provider-insurer payment disputes
Referral protections: Patients referred to out-of-network providers by an in-network provider are protected in certain circumstances
Filing Information
Within 2 years of the date of service for state-level complaints
Additional Notes
Massachusetts enacted balance billing protections years before the federal No Surprises Act. The state has robust consumer protection infrastructure. Self-funded employer plans also benefit from federal NSA protections.
How to File a Complaint in Massachusetts
Gather Your Documentation
Collect your itemized medical bill, Explanation of Benefits (EOB) from your insurer, any prior authorization documents, and written communications with the provider or insurance company.
File with the State Regulator
Submit your complaint to the Massachusetts Division of Insurance. Include all supporting documents and a clear description of the billing dispute.
File complaint with Massachusetts Division of InsuranceFile with CMS if Federal Protections Apply
If your dispute involves the No Surprises Act (emergency care or out-of-network providers at in-network facilities), you can also file directly with the Centers for Medicare & Medicaid Services.
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