Health Care Price Information Forms

New Law: Massachusetts General Laws Chapter 111 Section 228

Prior to an admission, procedure or service and upon request within two working days, a patient may request the allowed amount or charge of an admission, procedure or service. This must include the facility fees if a facility will be used.

We understand that you may not have this information relative to the facility fees, but you should assist the patient in getting this information. 

If you determine that the exact treatment or diagnostic code cannot be predicted, then the patient should receive information about the maximum allowed amount or charge for the admission, procedure or service.  If you are referring a patient to another provider that is part of the same provider organization as you, you must also disclose this to the patient. 

What to Do If Your Patient Requests Price Information 

If your patient is covered by a health insurance plan:

  • You may wish to contact the insurer directly on behalf of your patient or provide the patient with contact information for the plan along with the following:
    • The name of the facility where the service will be performed if appropriate
    • The CPT codes for the services to be provided
    • Any other information that can help facilitate the patient to identify the costs associated with the service
  • You may also be contacted by the insurer on behalf of your patient and you should assist the insurer by providing them with sufficient information so they can assist your patient/their insured.

If your patient does not have insurance: 

  • Please provide your patient your predicted maximum allowed amount to the extent that you can predict the services provided.
  • You should also provide your patient with:
    • The name of the facility where the service will be performed
    • The CPT codes for the services to be provided and; 
    • The phone or contact information for the billing office of the facility

Patient Information Forms

We have worked with the Mass Collaborative to develop a standard Cost Estimate Worksheet recognized by the plans to assist you in providing this information to the patient. 

Health Plan Contact Information

The Massachusetts Office of Consumer Affairs and Business Regulation has a list of health plan websites to help patients obtain accurate cost information specific to their health plan and contract.

For additional information visit www.massmed.org/prices or contact the Physician Practice Resource Center at pprc@mms.org or (781) 434-7702. 

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