The American Hospital Association and American Medical Association have joined with health care systems and independent providers in filing suit against the U.S. Department of Health and Human Services (HHS) regarding implementation of the No Surprises Act, which went into effect on Jan. 1, 2022.
Although the plaintiffs support the legislation itself — which was passed in 2020 and indemnifies patients from surprise medical bills arising from disputes between insurers and providers — they oppose a provision enacted in September 2021 that would require arbitration in cases where a resolution cannot be independently reached.
UNITED STATES – AUGUST 23: E. Barrett Prettyman United States Courthouse (Photo By Bill Clark/CQ Roll Call)
Under this provision, HHS has instructed arbiters to equate appropriate out-of-network charges with the median in-network rate for services, which the plaintiffs feel unfairly benefits payers. This action could interrupt provider networks and cause undue burden to patients by limiting access to necessary care. The lawsuit itself does not restrict the overall implementation of the No Surprises Act.
“Congress established important patient protections against unanticipated medical bills in the No Surprises Act,” Gerald E. Harmon, M.D., president of the American Medical Association, said in a press release. “But if regulators don’t follow the letter of the law, patient access to care could be jeopardized as ongoing health plan manipulation creates an unsustainable situation for physicians.”
A full copy of the complaint can be found here, along with a motion to stay pending judicial review.
