Amendment #55, as changed to H4617

Improving Notice Provisions for Out of Network Billing

Mr. Cassidy of Brockton moves to amend the bill in section 65 by inserting, in line 1431, after the words “emergency services,” the following words:- when said services are scheduled at least 24 hours in advance of the rendering of care,;

And moves to further amend the bill in said section 65, by striking lines 1494 through 1505, inclusive, paragraph (d) and inserting in place thereof the following paragraph:-

(d) Upon initial encounter with a patient at the time of scheduling an admission, procedure or service for an insured patient or prospective patient, an out-of-network provider shall, in addition to the actions required pursuant to subsection (b) and at least 24 hours in advance of care, when said care is scheduled at least 24 hours in advance of rendering the services: (i) disclose to the insured that the provider does not participle in the insured’s health benefit plan network; (ii) provide the insured with the estimated or maximum charge that the provider will bill the insured for the admission, procedure or service if rendered as an out-of-network service, including the amount of any facility fees; (iii) inform the patient or prospective patient that additional information on applicable out-of-pocket costs for out-of-network services may be obtained through the toll-free number and website of the insurance carrier available pursuant to section 23 of chapter 176O; and (iv) obtain the prior written consent of such patient or prospective patient in advance of the out-of-network provider rendering health care services. This subsection shall not apply in cases of emergency services provided to a patient.