Jim O Day
Representante estatal para el decimocuarto distrito de Worcester de Massachusetts
H.1078 An Act to limit retroactive denials of health insurance claims for behavioral health and substance abuse services
Health care providers are required to meet billing deadlines and get prior authorization before providing service in order to receive payment, while no such timeline exists for insurance companies to prevent them from recouping payment from providers for services delivered after the fact. This bill would prohibit insurers and other payers, including MassHealth and the Group Insurance Commission, from retroactively denying claims and recouping (or “clawing back”) previous payments to mental health and substance use treatment providers for services they have provided when 12 months or more have elapsed since the submission of the claim. This practice decreases the accessibility of behavioral health and substance use treatment because insurers can recoup reimbursements from providers for services rendered months or even years in the past, forcing small providers to pay enormous and unforeseen amounts.
Read the bill here.