Bill > S810

This bill amends Section 16 of Chapter 176O of the General Laws to address payment practices by health insurance carriers (also called "carriers") for medical services. Specifically, the bill prohibits carriers from reducing reimbursement rates for evaluation and management services or procedural services simply because a healthcare provider billed additional related health services on the same day. This means that if a doctor performs an initial patient consultation (evaluation and management) and also performs a minor surgical procedure on the same day, the insurance carrier cannot pay less for those services than they would normally reimburse. The bill also clarifies that for health benefit plans where the carrier only provides administrative services and does not directly pay claims, the carrier's obligation is limited to recommending claim coverage to the actual third-party payer. This legislation aims to ensure fair compensation for healthcare providers and prevent insurance carriers from arbitrarily reducing reimbursement rates when multiple services are provided during a single patient visit.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S810