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We are currently self-payers for medical services. We found that many providers have trouble dealing with this and in particular it's very difficult to get proper documentation of the services rendered and the payment received for it (which honestly should be a no-brainer).

In one example, we had to write checks up-front on the day of procedure and they declined to even just give a receipt for the payments with the bizarre explanation of "we don't do that". These are perfectly reputable establishments otherwise (no shady business).

Questions

  1. Is a medical service provider required to give a proper bill and/or receipt for payment (like e.g. retailers are)?
  2. If not, what is the minimum documentation a medical service providers needs to provide to a self-payer?
  3. Is there a requirement to disclose all known costs of a procedure up front?

2 Answers 2

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For the "render a proper bill" part, yes indeed!

Under Massachusetts General Law Part I, Title XVI, Chapter 111, Section 70E, a patient of a licensed medical facility is entitled to an itemized bill for services upon request, no matter who is paying. Subparagraphs of this law include:

Every such patient or resident of said facility in which billing for service is applicable to such patient or resident, upon reasonable request, shall receive from a person designated by the facility an itemized bill reflecting laboratory charges, pharmaceutical charges, and third party credits and shall be allowed to examine an explanation of said bill regardless of the source of payment. This information shall also be made available to the patient's attending physician.

And:

Every patient or resident of a facility shall be provided by the physician in the facility the right: (g) upon request to receive an itemized bill including third party reimbursements paid toward said bill, regardless of the sources of payment;

The law quoted above is quite long and verbose, and there are many other references to itemized bills that you will find by searching the full text.

This law is silent on the subject of receipts for payment by check, but as always a canceled check or an image of a canceled check provided by your bank is sufficient proof of payment.

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There is no requirement that a medical provider issue a receipt or any other proof of payment, either through federal law or Massachusetts law. There is a requirement to provide proof of payment indirectly imposed on a person under 130 Mass. Reg. 520.033, if the person seeks state medical assistance, and such a medical provider would pose a significant documentation problem for a customer in that circumstance. There is also no requirement to disclose "all known costs", however as a matter of general contract law, if they represent that your cost will be specifically and definitely exactly $100 then they cannot later charge you an extra $20. This explains why medical providers typically do not make any definitive assertions about cost, and why you sign a form (typically not read by the customer) saying that you will pay all expenses.

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