PocketLaw | Massachusetts General Laws | Health Insurance Consumer

Refusal of Carriers to Contract With Eligible Health, Dental or Vision Care Providers Solely Because Providers Have Practiced Good Faith Advocacy on Behalf of Patients

Section
5

Contracts; Liability

Section
5a

Acceptance and Recognition of Information Submitted Pursuant to Current Coding Standards and Guidelines Required; Use of Standardized Claim Formats

Section
5b

Policies and Procedures to Enforce Sec. 5a

Section
5c

Failure of Carrier to Comply With Coding Standards and Guidelines; Notice; Penalty

Section
6

Evidence of Coverage to Be Delivered to Covered Adults by Health, Dental and Vision Care Providers; Contents

Section
7

Agreements or Contracts Between Carrier and Health Care Provider Prohibited if Containing Certain Provisions

Section
9b

Alternate Payment Arrangements Involving Downside Risk Prohibited Without Risk Certificate

Section
10

Contractual Financial Incentive Plans

Section
11

Rights of Health Benefit Plans to Include as Providers Religious Non-Medical Providers

Section
12

Utilization Review

Section
13

Formal Internal Grievance Process; Expedited Resolution Policy

Section
14

Review Panel; Patient Protection Office

Section
15

Disenrollment of Provider; Continuation of Treatment; Specialty Health Care Coverage

Section
16

Clinical Decisions Regarding Medical Treatment Made by Treating Physicians; Payment for Health Care Services Ordered by Treating Physician or Primary Care Provider

Section
17

Regulations; Promulgation

Section
18

Responsibility of Carrier for Behavioral Health Services Compliance

Section
19

Display of Name and Telephone Number of Health Service Manager on Enrollment Cards of Carrier

Section
20

Information Provided to Insured Adults by Behavioral Health Manager; Submission of Material Changes; Workers' Compensation; Preferred Provider Arrangements

Section
21

Submission by Carrier of Annual Comprehensive Financial Statement

Section
22

Participation in Medical Assistance Program as Condition for Participation in Carrier's Provider Network

Section
23

Disclosure by Carrier Upon Request for Estimated or Maximum Allowed Amount or Charge for a Proposed Admission, Procedure or Service and Amount Insured Responsible to Pay; Establishment of Toll-Free Telephone Number and Website

Section
24

Internal Appeals Processes for Risk-Bearing Provider Organizations; Patient's Right to Third-Party Advocate; External Review Process

Section
25

Use and Acceptance of Specifically Designated Prior Authorization Forms

Section
26

Establishment of Standardized Processes and Procedures for the Determination of Patient's Health Benefit Plan Eligibility at or Prior to Time of Service

Section
27

Development of Common Summary of Payments Form

Section
28

Health Insurance Consumer Protections

Checkout our iOS App for a better way to browser and research.

Definitions

Bureau of Managed Care

Complaints Against Carriers; Notice; Hearing

Refusal of Carriers to Contract With Eligible Health, Dental or Vision Care Providers Solely Because Providers Have Practiced Good Faith Advocacy on Behalf of Patients

Contracts; Liability

Acceptance and Recognition of Information Submitted Pursuant to Current Coding Standards and Guidelines Required; Use of Standardized Claim Formats

Policies and Procedures to Enforce Sec. 5a

Failure of Carrier to Comply With Coding Standards and Guidelines; Notice; Penalty

Evidence of Coverage to Be Delivered to Covered Adults by Health, Dental and Vision Care Providers; Contents

Information Provided by Carrier Upon Enrollment or Upon Request

Failure by Carrier to File Annual Statement; Fine

Utilization Review Programs; Annual Attestations

Agreements or Contracts Between Carrier and Health Care Provider Prohibited if Containing Certain Provisions

Alternate Payment Arrangements Involving Downside Risk Prohibited Without Risk Certificate

Contractual Financial Incentive Plans

Rights of Health Benefit Plans to Include as Providers Religious Non-Medical Providers

Utilization Review

Formal Internal Grievance Process; Expedited Resolution Policy

Review Panel; Patient Protection Office

Disenrollment of Provider; Continuation of Treatment; Specialty Health Care Coverage

Clinical Decisions Regarding Medical Treatment Made by Treating Physicians; Payment for Health Care Services Ordered by Treating Physician or Primary Care Provider

Regulations; Promulgation

Responsibility of Carrier for Behavioral Health Services Compliance

Display of Name and Telephone Number of Health Service Manager on Enrollment Cards of Carrier

Information Provided to Insured Adults by Behavioral Health Manager; Submission of Material Changes; Workers' Compensation; Preferred Provider Arrangements

Submission by Carrier of Annual Comprehensive Financial Statement

Participation in Medical Assistance Program as Condition for Participation in Carrier's Provider Network

Disclosure by Carrier Upon Request for Estimated or Maximum Allowed Amount or Charge for a Proposed Admission, Procedure or Service and Amount Insured Responsible to Pay; Establishment of Toll-Free Telephone Number and Website

Internal Appeals Processes for Risk-Bearing Provider Organizations; Patient's Right to Third-Party Advocate; External Review Process

Use and Acceptance of Specifically Designated Prior Authorization Forms

Establishment of Standardized Processes and Procedures for the Determination of Patient's Health Benefit Plan Eligibility at or Prior to Time of Service

Development of Common Summary of Payments Form

Provider Directories; Contents; Audits; Print Copies; Customer Service Contact Information; Accommodations; Accuracy; Updates