The “Surprise Act” is a new Federal consumer protection law that protects patients from costly out-of-network billing charges related to emergency and urgent care treatment expenses. Effective Jan 1, 2022, the federal law protects patients from “balance billing” practices that allow hospitals, outpatient facilities and transportation companies to bill patients for amounts not paid by insurers for covered and non-covered service by out-of-network providers.
WHAT IS BALANCE BILLING?
"When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services."1
The “Surprise Act” does not impact the Acupuncture Profession or individual Acupuncturists working outside of a hospital-based in-patient or outpatient setting. As written, "the interim final regulation defines “facility” to include hospitals, hospital outpatient departments, and ambulatory surgery centers. It requests public comment on whether additional types of facilities should be added to this definition. Meanwhile, consumers do not have federal protections against surprise bills for non-emergency services provided in other facilities such as birthing centers, clinics, hospice, addiction treatment facilities, nursing homes, or urgent care centers. Patients seeking care at such facilities may want to ask whether doctors bill independently and whether they are in-network, and are intended the protections afforded under the Act apply to emergency and urgent care services rendered in and by hospitals, hospital outpatient facilities and certain patient transportation providers.” 2
Legislators and policymakers will continue to examine the meaning and impact of the definition for “facilities.” As that definition evolves it may come to included Acupuncturists’ offices, when and wherein the consumer protections covered under the Surprise Act will be extended to insurance billing practices in Acupuncturists’ offices. In the meantime, Acupuncturists should review their office’s Patients’ Responsibilities and Financial Practices Disclosure forms and decide if their language and policies clearly describe patients’ obligations, if any, to pay for services and amounts not fully covered by insurers.
- https://www.healthcare.gov/glossary/balance-billing/
- https://www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022/
David Bibbey AP, LAc has been servicing in the FSOMA Board of Director for the past 12 years, and took seat as the President of FSOMA in 2020.
David is the owner of Alternative Primary Care in Crystal River, FL and a faculty member at Florida College of Integrative Medicine in Orlando. He has over a decade of training and experience in evidence-based use of herbs and supplements.
David also considers activism and volunteerism hallmarks of professionalism; and, he has never asked another to contribute more than he is willing to give. Prior to becoming an Acupuncture Physician, David had careers in marketing, sales, operations management, and systems training.
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