Reimbursement Rate for Out-of-Network Emergency Services: Executive Order Potentially Sets Precedent

On April 9, 2020, Governor Baker issued an emergency order, mandating that insurers cover all medically necessary emergency department and inpatient services costs of COVID-19 treatment at both out-of-network and in-network hospitals and other medical facilities, without any cost to the patient, setting the OON reimbursement rate at 135% of Medicare, and prohibiting providers from balance billing. The Governor appears to have relied on § 7 of the Massachusetts emergency preparedness and response law in issuing the Order.  Section 7 gives the Governor broad powers during a state of emergency, including “[r]egulation of the business of insurance and protection of the interests of the holders of insurance policies and contracts and of beneficiaries thereunder and of the interest of the public in connection therewith.”

To read the full text of this post by Duane Morris attorney Emmy Monahan, please visit the Duane Morris Health Law Blog.