Nonpayment for Serious Preventable Adverse Health Care Events
The Plan implemented a policy in October 2008 to no longer pay for hospital-based costs
associated with 28 serious preventable adverse health care events. This nonpayment policy is
in line with Massachusetts legislation enacted in the fall of 2008. These adverse events are
based upon the work done by the National Quality Forum, a nonprofit coalition of physicians,
hospitals, businesses and policy-makers. Some of these events include:
- Surgery on the wrong body part
- Surgery on the wrong patient
- Patient death or serious disability associated with a medication error or contaminated drugs
See the complete list of the 28 serious preventable health care events for which
the Plan will no longer pay benefits.
In accordance with the current Department of Public Health (DPH) regulations, Massachusetts
providers are not permitted to bill members for designated serious reportable health care events.
Therefore, members will not be responsible for paying any charges in connection with events that the
Plan will not cover.
DPH has established requirements indicating that providers must report the occurrence of
these serious preventable events as defined by this new legislation. DPH has also provided
guidance to providers on what they are allowed to bill for regarding these events. The Plan
will follow the guidance of DPH in administering its nonpayment policy.
Get more information about serious adverse health care events for which the Plan will no longer pay benefits:
For Medicare Members
The Centers for Medicare and Medicaid Services (CMS) established a similar policy regarding
the nonpayment of serious preventable health care events in October 2008. For information on
this policy, contact CMS at 1-800-633-4227 (TTY: 1-877-486-2048).
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