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notice, including a good-faith estimate of the costs incurred and a list of in-network options for the patient. This notice and consent process, however, is not available for out-of-network pro- viders of emergency services and other ancillary services (such as anesthesiology, pathology, radi- ology, and other diagnostic services), or in cir- cumstances where there no in-network provider is available.
Other provisions of the No Surprises Act, including disclosure requirements for both pro- viders and health plans, also aim to increase transparency and consumer protections. Provid- ers are required to publicly disclose and provide to patients a one-page notice about the balance- billing requirements and prohibitions of the No Surprises Act, as well as state law. As discussed below, Massachusetts, too, has recently imposed new disclosure requirements for providers.
Notably, the protections of the No Surprises Act do not apply to emergency services by ground ambulance providers. In those circum- stances, out-of-network ground ambulance pro- viders may still bill patients for significant bal- ances, which are invariably a surprise to patients who had no ability to choose an in-plan ambu- lance provider in an emergency.
Regulations implementing the No Surprises Act have not been without controversy. Medi- cal associations have criticized the regulations implementing the dispute-resolution process as unfairly favoring health plans. Health plans, on the other hand, have lauded the regulations, maintaining that the process will make health- care more affordable and avoid unnecessary
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facing the obstacle of not being able to utilize a physical retail space. “The marketplace changed along with the world, so we had to be agile and change some of our approach as well.”
Cider House Media’s increase in activity dur- ing the pandemic did not stop with the growth of its clientele. “One thing that happened over the pandemic is an interesting market we got into — the community-access TV market,” Appelquist said. Since the beginning of the pandemic, Cider House Media has started five and launched four additional websites for public-access television.
“That’s been a real big education, and since one of the things we really love is to work with businesses, nonprofits, local organizations, arts organizations, touchpoints in our community that make a difference ... it was our first experi- ence building something that was a real journal- istic news resource. Things like that have been great.”
Cider House Media has been involved in sev- eral community-oriented projects, perhaps the most noteworthy and high-profile one being One Ferry Project, a mill-building revitalization proj- ect in Easthampton.
“Locally, we launched this year a new
brand and website for the One Ferry Project,” Appelquist said. “We did the brand, the logo, the marketing tools, all the signage for the building, the website. The process for potential renters
or buyers of space, condos, rental units, office space, we created a mechanism for them to inquire on the website and reach whomever they need to reach.”
Cider House Media has been engaging in its community ever since the couple moved into
increases in health-insurance premiums.
On Jan. 1, 2021, Massachusetts passed its own
law to address balance billing for non-emergen- cy services. That law, which also took effect on Jan. 1, requires healthcare providers to disclose to patients certain information regarding their participation in patients’ insurance plans and patients’ financial obligations for scheduled pro- cedures and services.
Generally, providers are required to tell patients whether they participate in the patient’s insurance plan. If the provider does not par-
changes during a continued course of treatment and make various disclosures when referring a patient to another provider.
There are two consequences if a provider violates the Massachusetts law. First, if an out- of-network provider fails to provide the required notifications and information, the provider cannot bill the patient at all, except for any co- payment, co-insurance, or deductible that would be payable had the patient received the service from an in-network provider. Second, the com- missioner of the Department of Public Health is
“If an out-of-network provider fails to provide the required notifications and information, the provider cannot bill the patient at all, except for any co-payment, co-insurance, or deductible that would be payable had the patient received the service from an in-network provider.”
ticipate in the patient’s plan, the provider must disclose the charges and any facility fees for the procedure or service. The provider must also inform the patient they will be responsible for the charges and any facility fees not covered through the patient’s health plan and that they may be able to obtain the procedure or service at a lower cost from an in-network provider.
The law also imposes new requirements on in-network providers to disclose information to patients regarding charges for procedures or services. Providers must also inform patients if their participation in the patient’s health plan
their office in Easthampton. Lennie and Eliza- beth are both members of the Cottage Street Cul- tural District Committee, and Elizabeth is on the board of the River Valley Co-op, as well as presi- dent of the Emily Williston Memorial Library
in Easthampton. Additionally, they have been regular participants in the Art Walk put on by Easthampton City Arts, which is a program that
“
have to be part of a community, to create community, to interact with community, are really, really important.”
features art exhibits and creative performances open to the public.
“When we got our office in Easthampton, we wanted to kind of be part of the community and meet people, so we actually asked the director
of Easthampton City Arts if we could be part of the Art Walk and have an artist display their work and have people over, and they were like, ‘abso- lutely, yes,’” Lennie said. “Almost from the time we opened our office in Easthampton, we were
a destination on the Art Walk as well as working with them.”
Lennie and Elizabeth opened an art gallery on Cottage Street in Easthampton as a second business in 2018, helping to celebrate the work
authorized to fine non-compliant providers up to $2,500 per violation.
The recently enacted federal and state laws seek to provide protections to consumers to avoid inadvertent balance bills from out-of-net- work providers. As these laws go into effect at the start of the new year, providers and health plans should be ready to implement the requirements, and consumers should see fewer surprises in their mailboxes. u
Jodi Miller and Ryan Barry are partners in Bulkley Richardson’s healthcare practice.
of local artists by hosting local art events, spoken word, and poetry. The gallery closed as a result of the pandemic, but Cider House Media still remains committed to supporting the arts in Hampshire County.
“One of the things in Easthampton, but also Pioneer Valley and Western Massachusetts, that I just find so, so amazing is how integral the arts are,” Lennie said. “Art, like commerce, is really important, and I think the art and the culture, and the ability to interact with art and meet the artist, and interact and find those people that you intersect with at those types of events ... it’s all your community.”
Word on the Street
Lennie Appelquist spoke of the charm pos- sessed by the walkable towns of Hampshire County, and how small details like connecting over the marquee sign or the local art exhibits creates a positively unique environment. He noted the ample opportunities for networking, partnerships, and synergies, describing a local butcher participating with a night with food at the local brewery. Above all, he emphasized the community-oriented nature of the area, and how gratifying it is to work with businesses in the county.
“All those opportunities that you have to be part of a community, to create community, to interact with community, are really, really impor- tant,” he said. “So I think that’s the part we like the most — helping a lot of our clients give voice to what excites them and drives them to do their business, and why they go do it every day.” u
All those opportunities that you
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