Surprise bills and ambulance bills in Massachusetts

When you schedule non-emergency care, a provider must find out whether it is in your plan's network. If it is out of network and the care was scheduled more than 7 days ahead, it must tell you orally and in writing at least 7 days before.

Checked against official sources: October 30, 2026.

What Massachusetts adds

State law: Massachusetts provider network-status disclosure law
Which plans it covers: Patients with health benefit plans regulated by Massachusetts. Self-funded employer plans are regulated by federal law.
What it adds: When you schedule non-emergency care, a provider must find out whether it is in your plan's network. If it is out of network and the care was scheduled more than 7 days ahead, it must tell you orally and in writing at least 7 days before. If the care was scheduled less than 7 days ahead, it must tell you orally at least 2 days before (or as soon as practicable) and in writing when you arrive. If an out-of-network provider does not give these notices, it may bill you only your in-network copay, coinsurance or deductible. A provider that schedules or orders care for you with another provider must first check that provider's network status and tell you if it is out of network or could not be checked.

Law: M.G.L. c. 111, § 228

Itemized bills and price estimates in Massachusetts

Massachusetts law gives you a right to an itemized bill.

Under the Massachusetts patients' rights law, a patient at a hospital, clinic or other licensed facility can ask for an itemized bill showing lab charges, pharmacy charges and insurance credits, and a copy of any itemized bill sent to an insurer. A patient can also ask a physician for an itemized bill including insurance payments, no matter who pays. The law does not set a number of days.

Law: M.G.L. c. 111, § 70E

Price estimates

If your provider is in your plan's network, you can ask for the allowed amount and any facility fees for a scheduled admission, procedure or service, and the provider must tell you within 2 days. If the provider is out of network, it must tell you its charge and facility fees when you schedule, and that you may owe what your plan does not cover.

Law: M.G.L. c. 111, § 228(b)

Where to complain in Massachusetts

Hospital bills and financial assistance: Health Safety Net Office (Executive Office of Health and Human Services) · 1-877-910-2100
You disagree with a Health Safety Net or Medical Hardship decision, or a hospital or health center billed you when the rules say it should not.
Attorney general: Massachusetts Attorney General, Health Care Division Helpline · 617-963-2100
Problems with medical bills, health insurance or health care providers.
Health insurance: Massachusetts Division of Insurance, Consumer Services Unit · 1-877-563-4467
Problems with a Massachusetts-regulated health insurance plan.
Debt collectors: Massachusetts Attorney General, Consumer Advocacy and Response Division · 617-727-8400
A debt collector broke state debt collection rules.

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Nearby states

National rules that apply in every state

Nonprofit hospitals (federal rules)

Each nonprofit hospital must have a written financial assistance policy (FAP).

Law: 26 U.S.C. 501(r)(4); 26 CFR 1.501(r)-4

Before any ECA, the hospital must tell you about financial assistance and wait at least 120 days from the first bill sent after you left the hospital.

Law: 26 CFR 1.501(r)-6(c)(3)

You can apply for at least 240 days from the first bill sent after you left the hospital.

Law: 26 CFR 1.501(r)-1(b)(3)

If you apply during the application period, even with an incomplete application, the hospital and its collectors must stop starting or continuing ECAs until the hospital decides, or until you fail to send requested information within a reasonable time.

Law: 26 CFR 1.501(r)-6(c)(8)

Once you are found eligible, the hospital cannot charge you more than the amounts generally billed (AGB) to people with insurance for emergency or other medically necessary care, and must charge less than its full gross charges for other covered care.

Law: 26 U.S.C. 501(r)(5); 26 CFR 1.501(r)-5

Surprise bills (No Surprises Act)

With most private health plans (job-based plans, Marketplace and other individual plans), you are protected from surprise out-of-network bills for emergency care, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.

Law: 42 U.S.C. 300gg-111, 300gg-131, 300gg-132, 300gg-135

For protected services, you can't be charged more than your in-network cost-sharing (copay, coinsurance, deductible).

Law: 42 U.S.C. 300gg-131, 300gg-132

Ground ambulance services are generally not covered by these federal protections, unless a state law has different rules.

Law: CMS, Know your rights when using insurance

If you don't have insurance or won't use it, providers and facilities must usually give you a written good faith estimate.

Law: 42 U.S.C. 300gg-136; 45 CFR 149.610

If one provider's or facility's bill is at least $400 more than its good faith estimate, you can use the federal patient-provider dispute resolution process.

Law: 45 CFR 149.620(a)(2)(ii), (c)(1)

Credit reports

A collection account generally cannot be reported for more than 7 years.

Law: 15 U.S.C. 1681c(a)(4), (c)(1)

For a veteran's medical debt (care authorized by the VA from a non-VA provider, or a bill the VA charged in error), nationwide credit bureaus may not report it until 1 year after the care, and may not report it once it is fully paid or settled, when they know it is a veteran's medical debt.

Law: 15 U.S.C. 1681c(a)(7), (8); 15 U.S.C. 1681a

If a medical debt on your credit report is wrong, you can dispute it with the credit bureau for free.

Law: 15 U.S.C. 1681i(a)(1)

Debt collectors

A debt collector must give you validation information about the debt, including the amount and how to dispute it.

Law: 12 CFR 1006.34

If you dispute the debt in writing within the validation period, the collector must stop collecting the disputed amount until it sends you verification of the debt.

Law: 12 CFR 1006.38(c), (d)(2)

A debt collector must not sue or threaten to sue you on a time-barred debt, meaning a debt whose statute of limitations has run out.

Law: 12 CFR 1006.26(b)

Itemized bills and price lists

Your medical and billing records kept by a health care provider are part of your 'designated record set'.

Law: 45 CFR 164.501 (designated record set); 45 CFR 164.524(b)(2)

If Medicare paid for an item or service, you can ask the provider in writing for an itemized statement.

Law: 42 U.S.C. 1395b-7(b)

Every hospital must post online a machine-readable file of all its standard charges, and a consumer-friendly list of at least 300 shoppable services (or an online price estimator tool).

Law: 45 CFR 180.40, 180.50, 180.60

Medicaid and Medicare

If you qualify for Medicaid, it can pay for covered care you got up to 3 months before the month you applied, if you were eligible then.

Law: 42 U.S.C. 1396a(a)(34), 1396d(a); Pub. L. 119-21, sec. 71112 (July 4, 2025)

If you are in the Qualified Medicare Beneficiary (QMB) program, Medicare providers may not bill you for Medicare deductibles, coinsurance or copays for Medicare-covered care.

Law: 42 U.S.C. 1396a(n)(3)(B); CMS

If your health plan denies a claim

You must file an internal appeal within 180 days (6 months) of the notice that your claim was denied.

Law: 45 CFR 147.136(b); HealthCare.gov

After a final denial, you can ask for an external review by an independent reviewer within 4 months.

Law: 45 CFR 147.136(c), (d); HealthCare.gov

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