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Medical Associations Push Forward With No Surprises Act Lawsuit

Analysis  |  By Jay Asser  
   April 27, 2022

ASA, ACEP, and ACR are pursuing their case following the government's appeal to a ruling that vacated parts of the surprise billing rule.

The American Society of Anaesthesiologists (ASA), the American College of Emergency Physicians (ACEP), and the American College of Radiology (ACR) are pushing forward with their lawsuit to block implementation of parts of the No Surprises Act.

On the heels of the Biden administration filing an appeal to a February U.S. District Court for the Eastern District of Texas ruling that vacated parts of the rule, the three medical associations are continuing with their case to prevent insurer use of the rule's independent dispute resolution (IDR) process.

ASA, ACEP, and ACR are aiming to protect patients' choices of providers and avoid the delay of diagnosis and treatment by targeting the narrowing of medical networks, potentially resulting in out-of-network bills.

Their case had been stayed while the government decided whether it would appeal the Texas court ruling. The Department of Health and Humans Services (HHS) will now pursue an appeal, according to filings from the Department of Justice.

The February ruling sided with the Texas Medical Association, which filed a lawsuit challenging how the HHS created an arbitration process for hospitals, doctors, and insurers to settle disputes over out-of-network bills under the No Surprises Act.

The court decided that HHS was mistaken in its decision to instruct mediators to give past contracted rates between insurers and providers extra weight compared to other factors during the IDR process.

Both the Texas case and the ASA, ACEP, ACR suit impact the IDR process to determine provider reimbursement for out-of-network care. Neither case affects patient protections against out-of-network bills.

"ACEP, ACR and ASA will work with legal partners and patient advocates to ensure that the Surprise Billing Interim Final Rule ultimately complies with the text and spirit of the No Surprises Act as passed by Congress," the associations stated in a release.

Jay Asser is an associate editor for HealthLeaders.


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