On Monday, the Texas Medical Association filed a brief continuing its opposition to how the No Surprises Act (NSA) determines out-of-network pricing. The brief challenges the motion for summary judgement by federal agencies to resolve the lawsuit the association filed in the Fall in response to the federal rule.
NSA went into effect January 1 and is intended to safeguard patients against surprise medical bills. For example, if a patient goes to the emergency room and the doctor on call is out-of-network, NSA is intended to make sure that patient only pays what he or she would if the provider were in-network. Physicians support the bill itself, but not a ruling from Fall 2021 on how the law would go into practice when determining the fair out-of-network pricing.
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The ruling in Fall 2021 said insurers would provide the median in-network amount for a service and use that to determine the price for out-of-network services. However, physicians take issue with how doing so does not account for a variety of other factors that could impact pricing, arguing this ruling gives insurers an unfair hand in determining pricing.
“The last thing federal regulators should do is make health care more expensive and less accessible for people when they need it, especially during a pandemic,” said E. Linda Villarreal, president of the Texas Medical Association in a news release. “The courts must reject the federal agencies’ flawed approach, because it goes against the public interest and our democratic process.”
The association filed a lawsuit on October 28, opposing the decision on payment dispute resolution methods and insurers’ advantage. Monday’s brief further supported this stance as it resisted the federal agencies’ summary judgement motion. Further, the brief opposes the federal agencies’ assertion of the group not having standing to pursue the case in the first place.
Oral arguments will begin on Feb. 4.
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Other provider groups have filed lawsuits citing the same issue. American Hospital Association and American Medical Association filed a suit in December. Association of Air Medical Services (AAMS) did so the month prior. Additionally, other physician groups – from Physicians Advocacy Institute (PAI) to American Association of Neurological Surgeons (AANS) to Congress of Neurological Surgeons (CNS) – have also submitted official briefs opposing the ruling.
As with the other official oppositions to the ruling, TMA’s brief and original suit support the patient protections afforded by NSA and are not seeking to alter them. The issue lies solely with the ruling on how to fairly determine out-of-network costs.
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