Massachusetts General Laws
Chapter 176g - Health Maintenance Organizations
Section 21 - Participating Provider; Contracts With Health Maintenance Organizations; Hold Harmless Clause; Limitation on Collection Actions

Section 21. (a) For purposes of this section, ''participating provider'' shall mean any physician, hospital or other person who, under an express or implied contract with the health maintenance organization or with its contractor or subcontractor, has agreed to provide health care services to members with an expectation of receiving payment, other than co-payment, co-insurance or deductible, directly or indirectly from the health maintenance organization, its contractor or subcontractor.
(b) Every contract between a health maintenance organization and a participating provider shall be in writing and shall contain the following hold harmless provision:
The provider agrees that in no event, including but not limited to nonpayment by the health maintenance organization of amounts due the provider under this contract, insolvency of the health maintenance organization or any breach of this contract by the health maintenance organization, shall the provider or its assignees or subcontractors have a right to seek any type of payment from, bill, charge, collect a deposit from, or have any recourse against, the member, persons acting on the member's behalf, other than the health maintenance organization, the employer or the group health maintenance contract holder for services provided pursuant to this contract except for the payment of applicable co-payment, co-insurance or deductibles for services covered by the health maintenance organization. The requirements of this provision shall survive any termination of this contract for services rendered prior to the termination, regardless of the cause of such termination. The health maintenance organization's members, any persons acting on the member's behalf, other than the health maintenance organization, and the employer or group health maintenance contract-holder shall be third-party beneficiaries of this clause. This provision supercedes any oral or written agreement hereafter entered into between the provider and the member, persons acting on the member's behalf, other than the health maintenance organization, and the employer or group health maintenance contract holder.
(c) In the event that the participating provider contract has not been reduced to writing as required by subsection (b) or that the contract fails to contain the required hold harmless provision, such provision shall be deemed incorporated into such contract by operation of law.
(d) No participating provider, agent, trustee or assignee thereof, may maintain any action at law against a member to collect sums owed by the health maintenance organization.

Structure Massachusetts General Laws

Massachusetts General Laws

Part I - Administration of the Government

Title XXII - Corporations

Chapter 176g - Health Maintenance Organizations

Section 1 - Definitions

Section 2 - Application of Laws

Section 3 - Organization; Accounting; Contracts

Section 4 - Required Coverage for Certain Conditions and Groups

Section 4a - Employees Terminated Due to Plant Closings; Coverage

Section 4b - Confidentiality of Information; Mental or Nervous Condition; Exceptions

Section 4c - Home Care Benefits

Section 4d - Nonprescription Enteral Formulas for Home Use

Section 4e - Off-Label Drug Use; Cancer Treatment

Section 4f - Group Health Maintenance Contracts; Coverage for Bone Marrow Transplants

Section 4g - Off-Label Use of Prescription Drugs for HIV/AIDS Treatment

Section 4h - Items Medically Necessary for Diagnosis and Treatment of Diabetes

Section 4i - Prenatal, Childbirth and Postpartum Care Benefits; Minimum Coverage for In-Patient Care

Section 4j - Scalp Hair Prostheses Necessary Due to Cancer or Leukemia Treatment

Section 4k - Newborn Hearing Screening Tests

Section 4l - Coverage for Hospice Services

Section 4m - Mental Health Benefits; Biologically-Based Mental Disorders; Rape-Related Mental Disorders; Non-Biologically-Based Mental Disorders of Children and Adolescents Under Age 19

Section 4n - Coverage for Speech, Hearing and Language Disorders; Hearing AIDS

Section 4o - Outpatient Services; Hormone Replacement Therapy for Peri and Post Menopausal Women; Contraceptive Services; Approved Prescription Contraceptive Drugs or Devices; Exception

Section 4p - Patient Care Services Provided Pursuant to Qualified Clinical Trials

Section 4q - Coverage for Human Leukocyte or Histocompatibility Locus Antigen Testing

Section 4s - Coverage for Prosthetic Devices and Repairs

Section 4t - Coverage for Eligible Dependents Under 26 Years of Age

Section 4u - Coverage for Medically Necessary Hypodermic Syringes or Needles

Section 4v - Coverage for Diagnosis and Treatment of Autism Spectrum Disorder

Section 4w - Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate

Section 4x - Coverage for Orally Administered Anticancer Medications

Section 4y - Coverage for Abuse Deterrent Opioid Drug Products

Section 4z - Preauthorization for Substance Abuse Treatment Not to Be Required

Section 4aa - Coverage for Medically Necessary Acute Treatment and Clinical Stabilization Services

Section 4bb - Coverage for Long-Term Antibiotic Therapy for Patients With Lyme Disease

Section 4cc - Coverage for Medical or Drug Treatments to Correct or Repair Disturbances of Body Composition Caused by HIV Associated Lipodystrophy Syndrome

Section 4dd - Filling of Remaining Portion of Prescription for Covered Drug That Is a Narcotic Substance Earlier Filled in Lesser Quantity

Section 4ee - Pain Management Access Plans

Section 4ff - Coverage for Tobacco Use Cessation Counseling and Tobacco Cessation Products

Section 4hh - Coverage for Long-Term Antibiotic Therapy for Lyme Disease; Experimental Drugs

Section 4ii - Coverage for Prescription Eye Drops

Section 4gg - Coverage for Treatment of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections and Pediatric Acute-Onset Neuropsychiatric Syndrome

Section 5 - Emergency Services Provided to Members for Emergency Medical Conditions

Section 5a - Divorced or Separated Spouses; Coverage

Section 6 - Contracts

Section 6a - Group Health Maintenance Contracts; Contribution Percentages

Section 6b - Retroactive Claims Denials for Behavioral Health Services

Section 8 - Public Dissemination of Deceptive or Misleading Materials

Section 9 - Trade Regulation Practices; Application of Law

Section 10 - Reports; Audits, Examinations or Inspections; Confidentiality and Privilege

Section 10a - Applicability of Chapter 176v to Health Maintenance Organizations Governed by This Chapter

Section 10b - Applicability of Chapter 176w to Health Maintenance Organizations Governed by This Chapter

Section 11 - Contracts With Group Insurance Commission or Local Governments

Section 11a - Alternative Dental Coverage Option

Section 12 - Health Regulations Not Limited

Section 13 - Name Restriction

Section 14 - Licensure Applicants; Documents Required; Approval by Commissioner

Section 15 - Bond; Waiver

Section 16 - Contracts, Rates, Evidence of Coverage; Disapproval of Commissioner

Section 16a - Disapproval of Certain Health Maintenance Contracts Based on High Deductibles

Section 16b - Disapproval of Certain Health Maintenance Contracts for Coverage of Young Adults

Section 17 - Rules and Regulations; Standardized Claim Form

Section 17a - Open Enrollment for Nongroup Medicare Beneficiaries; Period, Notice of Termination

Section 19 - Discrimination Against Abuse Victims in Terms of Health Maintenance Contract

Section 20 - Insolvent Health Maintenance Organization; Administrative Supervision, Rehabilitation or Liquidation; Priority of Claims

Section 20a - Administrative Supervision, Rehabilitation or Liquidation of Health Maintenance Organizations; Revocation or Suspension of License

Section 21 - Participating Provider; Contracts With Health Maintenance Organizations; Hold Harmless Clause; Limitation on Collection Actions

Section 22 - Health Care Providers; Liability of Member of Health Maintenance Organization; Limitation on Collection of Amounts Owed

Section 23 - Insolvency of Health Maintenance Organization; Replacement Coverage

Section 24 - Health Maintenance Contracts; Genetic Tests; Discrimination Based on Genetic Information

Section 25 - Net Worth of Health Maintenance Organization

Section 26 - Deposit Maintained With Trustee Acceptable to Commissioner

Section 27 - Merger or Acquisition of Control

Section 28 - Registration With Commissioner

Section 29 - Violations of Secs. 27 to 29; Application for Order Enjoining Violations of Secs. 27 to 29; Penalties

Section 30 - Statement for Individuals Provided With Creditable Coverage; Reporting

Section 31 - Attribution of Members to a Primary Care Provider

Section 32 - Disclosure of Patient-Level Data and Contracted Prices of Individual Health Care Services by Carriers to Providers

Section 33 - Coverage for Health Care Services Delivered via Telehealth by a Contracted Health Care Provider