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Healey orders work on standard out-of-network rates to curb surprise billing
Summary
Governor Healey directed the state insurance commissioner to work with insurers and providers to establish set standard rates for out-of-network services and close loopholes that produce surprise medical bills, saying the change will lower premiums and patient financial shocks.
Governor Maura Healey said one of the administration's first priorities from the Health Care Affordability Working Group is eliminating surprise billing by establishing standard rates for out-of-network care.
"We're going to prevent that from happening going forward because nobody should be surprised with a big bill," Healey said, directing the commissioner of insurance to negotiate a standard rate framework with insurers and providers and to identify and close loopholes that allow surprise charges to persist.
The administration described the standard-rate approach as a regulatory and negotiation effort: the Division of Insurance will engage both provider and insurer stakeholders to define rates that would apply when patients receive care outside a provider network. Healey said doing so is intended to reduce premium costs passed on to consumers and reduce unexpected individual bills.
In questions, attendees asked how the state will secure provider acceptance of default rates; Healey responded that Commissioner Caljo will lead the work and that the administration will rely on stakeholder collaboration to make the approach workable.
