Medical groups support No Surprises Act lawsuit 

Photo: Thomas Barwick/Getty Images

Three physician groups are supporting a second lawsuit brought by the Texas Medical Association against the federal departments responsible for the No Surprises Act implementation.

The American Society of Anesthesiologists, the American College of Emergency Physicians and American College of Radiology filed a joint amicus brief with the federal court in Texas on October 19 in support of the new lawsuit brought by the Texas Medical Association.

The group said they support safeguarding patients from surprise medical bills but that the No Surprises Act's implementation has created serious problems for physicians and other healthcare providers. 

"The flawed implementation has caused unreasonably low payments from insurers to out-of-network practices, insurers declining all negotiations during the 30-day negotiation period and overwhelming delays in the independent dispute resolution (IDR) process with IDR entities receiving thousands of claims, with some no longer accepting claims, and few being resolved," the ASA said. "Additionally, while they are experiencing record profits, insurers are using the Act to force in-network physicians out-of-network, creating narrower networks." 

WHY THIS MATTERS

In December 2021, the American Hospital Association, American Medical Association and others sued the Department of Health and Human Services and the other federal agencies over implementation of the No Surprises Act.

The groups were not against the legislation, they said in the lawsuit, but took issue with how HHS implemented the Internal Dispute Resolution process to resolve payment rates between provider and payer. The interim final rule stipulated that the arbitrator must select the offer closest to the Qualifying Payment Amount, which is set by the insurer.

In August, the U.S. Departments of Labor, Health and Human Services, and the Treasury issued final rules to clarify the arbitration process. 

The three medical groups argue that implementation continues to favor insurers and the IDR process still fails to comply with the No Surprises Act statutory text. 

"The final rule, issued in August, skews the IDR process to favor the insurer-calculated Qualifying Payment Amount over other factors Congress specifically directed IDR arbitrators to consider equally with the QPA," the ASA said. "Insurers are using the new law to raise profits by initiating reductions in contracted fee schedules and narrowing medical networks, which denies patients their choice of providers and can delay diagnosis and treatment of illness and injury."  

In possible violation of the No Surprises Act, insurers are likely using lower primary care provider contract rates in calculating QPA, the ASA said.  

Also, Blue Cross Blue Shield of North Carolina, Blue Cross Blue Shield of Tennessee and Cigna of Tennessee have cited the new law in demanding providers accept drastic cuts in payment for services provided or risk contract termination, the ASA said.  
 
THE LARGER TREND

Patients get a surprise bill when they are charged – most often unknowingly – for using an out-of-network physician.

On December 27, 2020, the Consolidated Appropriations Act, which includes the No Surprises Act, was enacted to give patients protections against surprise billing by limiting out-of-network cost-sharing and prohibiting balance-billing.

Surprise medical bills have most often come from patients using four medical specialists, including the three groups that are bringing the lawsuit: anesthesiologists, pathologists, emergency medicine physicians and radiologists, according to 1% Steps for Healthcare Reform. Patients have little choice when seeing these specialty physicians, who can bill out-of-network from in-network hospitals, according to the report. 

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org