Interpreting No Surprise Billing law for prior-auth surgery on Texas ACA plan?

Hi, helpful community:

My kid is on an ACA plan in the state of Texas. He is scheduled for orthopedic surgery tomorrow for complications resulting from chemotherapy (the kid can't catch a break).

I urged him to double-check he had prior auth for everything today. The hospital and the doctor are in-network and he has already received prior auth. HOWEVER, the anesthesiology group that the hospital uses–and about which he has no choice–is not in network.

Here's what the insurer says about No Surprise Billing.

Is this surgery considered "elective" because he gets to choose when it happens (as opposed to an emergency service that must be treated immediately) so if he does it, he's on the hook for the out-of-network anesthesia bill? Or, because the hospital and surgeon are in network, and he has no choice about the anesthesia, does the No Surprises act apply and he can go ahead and get the surgery with some degree of confidence that the anesthesia will eventually be covered?

TIA.

submitted by /u/pragmaticallies
[comments]

See also  Beneficiarios de Medi-Cal: cรณmo verificar si eres elegible