MA H1126

Health care providers must disclose to patients whether they participate in the patient's health benefit plan when scheduling non-emergency admissions, procedures, or services

For in-network providers, the provider must submit good faith billing estimates and diagnostic codes to the patient's insurer, which must then provide the patient with estimated out-of-pocket costs within 3 business days (or 1 business day if scheduled less than 10 days in advance)

Out-of-network providers and those treating uninsured patients must provide good faith cost estimates including facility fees within 1-3 business days depending on scheduling timeframe

Non-participating providers who fail to provide required cost notifications cannot bill the patient beyond what would be owed to an in-network provider (copayment, coinsurance, or deductible)

Penalties for non-compliance by providers or insurers are capped at $2,500 per instance, and no state penalty applies if CMS or the Massachusetts Division of Insurance has already penalized the same violation