February 08, 2023

Medical Societies Call TX Federal Court Surprise Billing Ruling A Victory for Patients and Providers

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Decision Strikes Down IDR Provisions Tilted Toward Insurers

 

The American College of Emergency Physicians (ACEP), American College of Radiology (ACR), and American Society of Anesthesiologists (ASA) are pleased that a Texas federal court ruled Feb. 6 in favor of the Texas Medical Association’s (TMA) second legal challenge to the improper implementation of the No Surprises Act (NSA). This ruling does not impact the patient protection provisions of the NSA, which all three societies continue to support.

The TMA lawsuit raised significant concerns about the flawed implementation of the NSA, namely that arbiters were required to give preferential treatment to the insurer-calculated Qualifying Payment Amount (QPA), a step that inappropriately slanted the independent dispute resolution (IDR) process toward insurance companies.

The court’s ruling effectively strikes down these provisions, restoring balance and fairness to the dispute resolution process itself. But further reform is necessary to make sure that the IDR process is accessible to physicians, as Congress intended.

The administration’s recent 600% increase in its administrative (non-refundable) IDR fee, from $50 to $350, has placed this process fundamental to the NSA almost entirely out of reach for many physician groups, once again tipping the balance toward insurance companies.

The three organizations said:

“We are pleased that the Texas court recognizes the need to make sure the No Surprises Act is implemented as Congress intended, rather than finalizing a flawed process that would give insurance companies an unreasonable advantage in arbitration.”

“The Texas court is right to strike down provisions that would have required arbiters to prioritize their determinations on the QPA — a figure that insurers miscalculate and artificially drive lower to the detriment of physicians and patients. Instead, this ruling restores fairness to the process, allowing the No Surprises Act to protect patients without compromising access to care.”

“This ruling means that arbiters will now consider all of the factors mentioned in the legislation instead of giving undue preference to the QPA in arbitration. ACEP, ASA and ACR filed an amicus brief in support of TMA which was referenced in the ruling.”

“This ruling is an important step in the right direction. Still, significant reform is necessary to make sure that the IDR process functions and remains accessible as the law intends. A fair and balanced process is still out of reach for many physician groups, especially smaller independent practices.”