Surprise Medical Bills Are Back in the Spotlight as an Unfair Practice

Patient with cast worried about medical billsBecause we represent clients in personal injury and medical malpractice cases, we know medical bills are a huge stress. Many people leave the hospital and actually feel worse, anticipating all the medical bills.

In most cases, you can ask your health insurance provider to pay and they will at least cover a portion. Except if you receive a bill for an “out-of-network” doctor or hospital. These are “surprise medical bills,” often incurred during emergencies, when patients may not have a choice about where to receive care. You can also get hit with these bills if an out-of-network physician treats you as part of your care at an in-network hospital or medical office.

This is a stressful situation for anyone. Not only is a patient asked to pay the medical bill, they are often charged more than an insurance company, with all its resources, would ever pay. Which isn’t at all fair.

What can be done? Gov. Charlie Baker is working to prohibit surprise medical bills as part of the health care bill he introduced in January. Federal lawmakers have also made two proposals.

Massachusetts Legislation on Surprise Medical Bills

Patients have been left bruised and aching by surprise medical bills in Massachusetts. We saw a small glimpse in March 2019, when The Boston Globe reported patients filed 115 complaints over two years about surprise medical bills.

As a result, the attorney general’s office found patients were being treated in either a physician’s office or urgent care center. But it was the parent company which sent the bill. Partners Health Care and its hospitals settled with the AG over this practice and should have changed practices to better inform patients.

In 2019, Massachusetts lawmakers proposed B.967. This legislation would require patients to provide specific consent to receive out-of-network health care service. Providers would no longer be able to bill consumers for more than in-network cost-sharing. Gov. Charlie Baker has also included the measure in his health care legislation proposed in January.

Federal Legislation on Surprise Medical Bills

Meanwhile, we saw surprise medical bills come in Congress last week. On Feb. 11th, the House Education and Labor Committee approved a bill to protect patients from surprise medical bills. This was a bipartisan vote, split 32-13 to send the measure to the full House of Representatives. Rather than overcharge a patient who is out-of-network, the bill would set payment for surprise medical bills based on the median amount for the geographic area.

The House Ways and Means Committee is working on different legislation. The approach is to bring in an outside arbitrator to make payment decisions. Hospitals and physician groups have supported this bill, but others say it risks driving up health-care premiums.

Tips for Protecting Your Wallet When Receiving Medical Care in Massachusetts

Here are our suggestions to help you protect against unsafe medical billing and care:

Always use electronic medical record systems. Request access at  your primary care physician’s office and at any doctor you see.

Massachusetts Patient’s Bill of Rights. M.G.L. c. 111, § 70E details the Massachusetts Patient’s Bill of Rights. This law states you have the right to inspect your medical records and the right to make decisions about privacy in your medical care.

Request an estimate for your medical procedure. While you cannot plan for every emergency, in Massachusetts, you have the right to ask, “How much does that cost?” before many procedures. You have this right because Massachusetts passed a health pricing transparency law in 2015. You can now request estimates from several doctors and decide where you want to be treated based on costs, ratings, online patient reviews and travel time from your home.

Under M.G.L. c. 111, § 228, you can request pricing from a doctor, health care provider or hospital. They must provide you with the following: how much the health care provider will be paid by an insurance carrier or what the charge will be if you self-pay or have an out-of-network service. Health care providers are given two business days to provide the information.

When doctors and hospitals cannot provide specific pricing, they must provide you with an estimated maximum charge.

You can ask the health provider directly. If you have health insurance, you can ask the company for assistance if you think it will be beneficial. We suggest that you request the price on your own first.

Some medical providers have online forms you can easily fill out and these provide examples of what information you may need. For example, while it’s helpful to have your surgery scheduled for a certain date and time, it’s not required when you request an estimate. Here is one example from Massachusetts General Hospital website.

About Breakstone, White & Gluck – Boston Medical Malpractice Lawyers

Breakstone, White & Gluck has over 100 years combined experience representing those injured by medical malpractice an surgical errors in Massachusetts. If you have been injured by someone else’s negligence, learn your legal rights for seeking financial compensation at 800-379-1244 or 617-723-7676. You can also use our contact form.

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