MA S762

Health care providers must disclose whether they participate in a patient's health benefit plan when scheduling non-emergency admissions, procedures, or services, with an exception for ongoing courses of treatment where initial disclosure was documented

In-network providers must submit good faith estimates of billing and diagnostic codes to insurers, who must then provide patients with estimated out-of-pocket costs within 3 business days (or 1 business day if scheduled less than 10 days out)

Out-of-network providers or those treating uninsured patients must provide good faith estimates of charges and facility fees within 1-3 business days depending on scheduling timeline, and must inform patients they may find lower costs with in-network providers

Providers who fail to provide required cost disclosures to out-of-network or uninsured patients may not bill beyond what the patient would have owed at in-network rates (copayment, coinsurance, or deductible)

Penalties for non-compliance are capped at $5,000 per instance for both providers and insurers, with no state penalty if CMS or the Massachusetts Division of Insurance has already penalized the same violation