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ACHI Health Policy Director Discusses New Legal Protections Against Surprise Medical Billing

January 19, 2022

Author

John Lyon
Strategic Communications Manager
501-526-2244
jlyon@achi.net

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A new federal law, the No Surprises Act, seeks to protect patients from surprise medical bills. In an interview Tuesday with KATV, ACHI Health Policy Director Craig Wilson explained what surprise billing is and how the law is supposed to work.

“Prior to January 1 of this year, out-of-network providers could bill consumers for the difference between what they charged for their services and what the insurance company would pay,” he said. “That’s called balance billing, and sometimes that’s really unexpected for consumers. That’s why it’s called surprise billing.”

The No Surprises Act prohibits healthcare providers from issuing surprise medical bills for out-of-network services. This includes most emergency services ”• although ground ambulance services are excluded ”• and non-emergency services provided by out-of-network providers at in-network facilities.

“For example, if you went to have an outpatient surgical procedure and maybe the anesthesiologist was out of network, [the law] would protect you from a surprise medical from that particular provider,” Wilson said.

For more information, see our previous posts on how the new law applies to air ambulance bills and dispute resolution.