COVER STORY


Surprise Medical Billing Update


What ASCs need to know to help patients avoid unexpected costs BY ROBERT KURTZ


O


ver several years, congressional hearings and the continued rise in the cost of healthcare and patient copays contributed to a heightened awareness of the ill effects of sur- prise medical bills. At the same time, organizations like AARP, local gov- ernments and the media were sharing guidance for patients on how to protect themselves from these bills. National media, such as ProPublica and Kai- ser Health News, also were regularly reporting on the negative impact sur- prise


medical bills could have on


patients, and consumers were sharing their surprise medical billing stories with the media and government offi- cials, asking for relief. The COVID-19 pandemic put sur- prise medical billing on even more people’s radars, says Ryan Blaney,


8 ASC FOCUS APRIL 2021 | ascfocus.org


a partner in Proskauer Rose who is based in Washington, DC. “There were provisions around surprise medical


billing included in some


[pandemic] relief bills. The provi- sions largely focused on laboratories, COVID-19 testing and other areas concerning the coronavirus, but the fact that surprise medical billing was included shows it is a top issue.” On December 27, President Trump


signed H.R. 133, the Consolidated Appropriations Act, 2021. One of the provisions of this bill limits the practice of balance billing patients that leads to what is commonly called “surprise medical bills” (see sidebar on page 9). The medical bills described as a “surprise" are not new types of bills, says Glenn Wilkins, client services manager for in2itive Business Solu-


tions in Overland Park, Kansas. What is new—and thus largely responsi- ble for the surprise labeling—is the amount of the bills and how patients react to them. A surprise medical bill, also referred to as a balance bill, occurs when a patient receives a bill for services not covered by insurance, i.e., out of network. Since out-of-network providers tend to charge more than insurers pay, the balance falls to patients. As insurance plans have moved away from offering out-of-net- work benefits, uncovered care can lead to high patient bills. “The surprise not only concerns the


bill's amount, but also a patient's expec- tation that the services they received were in network and thus covered,” Wilkins says. “Out-of-network ser- vices can lead to patient bills that are unexpectedly higher than they would have been if those same services were delivered by an in-network provider.”


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