No Surprises Act dispute resolution challenge

No Surprises Act dispute resolution challenge

The AHA and American Medical Association yesterday filed a friend-of-the-court brief in support of a Texas Medical Association lawsuit claiming the revised independent dispute resolution process for determining payment for out-of-network services under the No Surprises Act skews the arbitration results in commercial insurers’ favor in ways that violate the compromise Congress reached in the Act.

The departments of Health and Human Services, Labor, and the Treasury revised the IDR process in August after a federal court in Texas vacated their instruction that IDR entities presume the appropriate payment amount for out-of-network services is the offer closest to the qualifying payment amount, essentially the payer’s median contracted rate.

“Based on their own apparent policy preferences, the Departments continue to add atextual requirements to Congress’s simple framework,” AHA and AMA wrote. “Indeed, six months after this Court definitively interpreted the No Surprises Act, the Departments promulgated a Final Rule with numerous extra-statutory requirements that will interfere with a balanced consideration of Congress’s mandated factors and put a thumb on the scale in favor of the QPA. … The severe rate cuts enabled by the Departments’ insurer-friendly regulations threaten the viability of physician practices and the scope of medical services nationwide. Ultimately, the victims will be the patients who lose ready access to care.”

The AHA and AMA strongly believe that no patient should fear receiving a surprise medical bill and that patients should be kept out of the middle of any billing disputes between providers and commercial health insurance companies. The groups want to see the law’s core patient protections move forward and seek only to bring the regulations in line with the law.

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