In last Friday’s edition of BostonGlobe.com that was re-printed in the Sunday (3/31/19) edition, an article re “Surprise Billing” was published.
The definition of “Surprise Billing” is when a patient has services rendered at a facility and, unbeknownst to the patient, some providers involved in the patient’s care are not participating with the patient’s medical insurance carrier. It results in the patient being personally responsible for part or all of the costs generated by the non-participating provider. Both Nationally and locally in Massachusetts, complaints are on the rise, especially because high deductible health insurance plans are more prevalent in the marketplace.
The article cites specific facilities, specialties and practices. It gives little in terms of specifics regarding the source of the reason for the lack of participation i.e. groups having difficulty in negotiating participating agreements, insurance carrier red tape to obtain payment and especially their low reimbursement rates for services provided (especially by the National carriers), etc.
The Massachusetts State legislature once again will address this sometime this year. Should legislation pass, it will likely result in a limit on the reimbursement for those providers who do not participate.
HMA will keep you abreast of the subject as it develops.