Surprise Billing

Update: TMA Pushes for Compliance With Second Surprise-Billing Win Amid Backlog of Payment Disputes - 03/24/2023

Amid much wrangling with federal regulators, the Texas Medical Association is taking steps to hold them accountable for complying with TMA’s second legal victory nullifying certain rules governing out-of-network payment disputes under the No Surprises Act.

New TMA Lawsuit Challenges Big Fee Hike in “No Surprises Act” Arbitration - 02/10/2023

The Texas Medical Association (TMA) is challenging a 600% hike in administrative fees for seeking federal dispute resolution in No Surprises Act (NSA) situations. TMA seeks relief by filing a fourth lawsuit in the U.S. District Court for the Eastern District of Texas.

UPDATE: TMA Sues Feds – Again – Over Unfair Arbitration Process Under Federal Surprise Billing Rule - 02/10/2023

The Texas Medical Association is back in court – again – to hold federal regulators accountable for implementing a key piece of the No Surprises Act as Congress intended it: to operate an arbitration process that does not skew the dispute resolution process in favor of health plans.

Legislative Priority #9: Network Adequacy, Surprise Billing - 02/10/2023

The Texas Medical Association wants to see enhanced enforcement of and accountability under state network adequacy laws and to protect Texas' surprising-billing law during the 2023 legislative session.

Feds Delay Portion of “Good Faith Estimate” Requirements Under Surprise Billing Law - 02/10/2023

Despite ongoing litigation over certain aspects of the federal surprise billing law, many of the patient protection components of the No Surprises Act still took effect in 2022. However, enforcement of a price transparency measure slated for Jan. 1, 2023, has been delayed indefinitely, giving physician practices more time to prepare.

TMA Seeks to Protect Patients’ Access to Care in New “No Surprises Act” Rules Lawsuit - 02/10/2023

Amid concerns about threats to patients’ access to physicians’ care, the Texas Medical Association has filed a new lawsuit in the U.S. District Court for the Eastern District of Texas, challenging certain portions of the July 2021 interim final rules implementing the federal No Surprises Act. This is the third lawsuit TMA has filed against federal agencies related to rulemaking under the law.

No Surprises Act Includes Directory Update Requirement - 02/10/2023

In addition to resolving payment disputes over out-of-network medical care, the federal No Surprises Act aims to make sure health plans’ practitioner directories stay up to date, and part of that aim puts an onus on physicians.

TMA Win on Surprise-Billing Rule Also a Win for Access to Care - 02/10/2023

When the Texas Medical Association scored a win over federal regulators in a Feb. 23 U.S. district court decision, it wasn’t just a victory for physicians. It was a victory for patients, too, cheers Houston emergency physician and TMA Immediate Past President Diana Fite, MD.

Feds Finally Open Dispute Portal Under Surprise-Billing Law - 02/10/2023

Physicians needing to formally settle a dispute with insurers over certain out-of-network payments under the federal No Surprises Act finally can initiate that process online.

Learn About Surprise-Billing Law’s “Good Faith Estimates” - 02/10/2023

Federal authorities have released a frequently asked questions (FAQ) document on providing “good faith estimates,” included as part of the federal No Surprises Act geared toward curbing surprise medical bills.

Federal Memo Signals Compliance With TMA Court Win – For Now - 02/10/2023

Within days of the Texas Medical Association’s Feb. 23 court victory over federal regulators, the U.S. Department of Health and Human Services (HHS) says it’s taking steps to comply with the court’s decision on rules for the No Surprises Act – even as HHS is “considering next steps” after TMA’s win.

TMA Welcomes U.S. District Court Decision to Grant Its Summary Judgment Motion - 02/10/2023

Statement by Diana L. Fite, MD, Texas Medical Association (TMA) immediate past president, in response to the U.S. District Court for the Eastern District of Texas’ ruling on TMA’s motion for summary judgment in its lawsuit opposing federal regulatory agencies’ dispute resolution approach under the No Surprises Act.

Surprise Billing Rules Garner More Legal Action - 02/10/2023

Pressure is mounting on federal authorities with several legal actions now aiming to stop what physicians and hospitals say is an unfair arbitration process outlined in rules implementing the No Surprises Act, legislation passed in 2020 to address surprise medical bills.

Federal Fairness? Congressional Measure Addresses Out-of-Network Payments - 02/10/2023

Congress in December 2020 passed surprise-billing legislation as part of a wide-ranging coronavirus relief bill, tying a bow on federal lawmakers’ primary health care focus just prior to COVID-19. Texas already had set up its own system for state-regulated plans in 2019 with Senate Bill 1264, which took effect last year.

TMA Keeps Pressing Congress on Surprise Billing - 02/10/2023

As lawmakers continue their work on a federal solution to surprise medical bills, the Texas Medical Association is on guard to make sure patients will be protected – and physicians get a fair shot to get paid properly. TMA joined 18 other state medical and specialty societies on a letter last week to the chairs and ranking members of three U.S. House committees.  

California Model Benefits Insurers, at Physicians’ and Patients’ Expense, Physicians Tell Congress - 02/10/2023

Texas Medical Association physician leaders, along with their colleagues from California and the rest of the country, are on Capitol Hill this week, lobbying Congress to toss out a California-inspired provision from a rapidly moving health insurance bill.

Making Billing More Balanced: Congress Considers Surprise Billing Legislation - 02/10/2023

The widespread call to severely curb or end “surprise” medical bills prompted competing federal legislation during the summer and fall of 2019. The negotiations, maneuvering, and bill markups have continued into this year.   

TDI Explains Arbitration Law Process - 02/10/2023

Before you’re involved in an out-of-network medical bill dispute that would be covered by the state’s new baseball-style arbitration law, it’s best to know what could be in store.  The Texas Department of Insurance has provided further details on how the law will be implemented, including how the arbitration process will work.

TMA Stands Firmly Against Surprise Medical Billing “Compromise” - 02/09/2023

“There is a right way and a wrong way to protect patients from surprise medical bills, and the so-called compromise federal legislation announced this weekend in Washington, D.C., is definitely the wrong way,” Texas Medical Association President David C. Fleeger, MD, said Monday.

TMA Makes Strong Push for Fair Surprise Billing Legislation - 02/09/2023

The Texas Medical Association is urging Texas lawmakers in Washington, D.C., to show their support for federal legislation on surprise medical bills that includes commercially reasonable upfront payments and independent arbitration.

Medicine to Congress: Don’t Give Health Plans More Leverage - 02/09/2023

The federal government should take a balanced approach to surprise medical bills that includes commercially reasonable upfront payments and independent arbitration, the Texas Medical Association and many other medical societies are telling key members of Congress.

Take Patients Out of the Middle of Balance Billing – The Right Way - 02/09/2023

We are very much supportive of the need to protect the patient from a surprise out-of-network bill; however, our opposition to HB 3933 is driven by the modification of the mediation process and Texas law in a way that allows insurers to have more control over the market and places more of a financial burden on physicians and their practices.

Say No To Bill That Would Take Physicians Out Of Balance Billing - 02/09/2023

The Texas Medical Association is fighting a bill working its way through the Capitol that would allow insurance plans to unilaterally determine payment for out-of-network billing.

TMA Offers Remedies to Ease Surprise Billing - 02/08/2023

Texas patients sometimes feel the pain from unexpected out-of-pocket costs not covered by their health insurance, known as “surprise billing” or “balance billing.” The Texas Medical Association (TMA) is taking aim at the problem, which occurs when a health insurance company pays less than what a doctor charges, leaving the patient to pay the balance of the bill.

Closing the Gap - 02/08/2023

Balance billing was one of TMA's biggest legislative wins this year. Senate Bill 507 will expand mediation for out-of-network bills, but nasty financial surprises for patients won't end when it takes effect on Jan. 1.