The federal No Surprises Act became effective Jan. 1, 2022. It established a federal law prohibiting balance billing for out-of-network, self-pay, and uninsured patients from certain surprise medical bills. The law also created patient price transparency rules by requiring certain physicians to provide their patients with good faith estimates.
The Texas Medical Association successfully sued federal regulators four separate times asserting they failed to implement the No Surprises Act (NSA) dispute resolution provisions as directed by Congress, with negative consequences for practice viability and ultimately patient access to care. Here are the latest developments on TMA's victories, which continue to have ripple effects nationwide.
Fifth Circuit Delivers TMA Win, Faulting Fed Error for “Upending” Surprise-Billing Dispute Resolution Process
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Texas law and federal legislation both have systems to address payment disputes between physicians and health plans using independent dispute resolution (IDR). But they also have some key differences.
Check out these TMA materials on the independent dispute resolution process, physician charges, and health plan contracting and networks.
Letters to Federal Independent Dispute Resolution (IDR) Entities re: TMA III
Educational Letters to Federal Certified Independent Dispute Resolution (IDR) Entities
Resources Concerning the No Surprises Act
The Real Truth About Surprise Bills
Physician Charges Do Have Meaning
Required Notices: No Surprises Act Notices with Certain Posting Requirements
SB 1264 and Out-of-Network Claims: Texas Arbitration Process
How to Appeal Being Dropped From a Network
Physician Prices, Fee Schedules, and Managed Care Contract Offer and Acceptance
Much of the federal government’s solution to resolve certain out-of-network billing disputes took effect at the start of 2022. To help physician practices understand and navigate the new law, the American Medical Association has created two No Surprises Act toolkits. TMA also offers an updated list of resources on the new law.
Read about Preparing for Implementation of the No Surprises Act.
Read about Disputing Out-of-Network Payments Using the No Surprises Act Independent Dispute Resolution Process.
View the AMA webinar, Out-of-Network Payment Process Under the No Surprises Act, that was held on Thursday, Apr. 21. Access a recording of the webinar and the presenters' slides.
TMA Considers Next Steps in Split Victory Over Payment Calculations in Surprise-Billing Arbitrations Texas Medicine Today, Nov. 15, 2024
TMA Applauds Appeals Court’s Ruling in Physicians’, Patients’ Favor Texas Medicine Today, Aug. 6, 2024
TMA Wins Appeal Upholding Its Challenge to Skewed Federal Surprise Billing Rule Texas Medicine Today, Aug. 5, 2024
TMA Wins Two More Surprise Billing Lawsuits; CMS Suspends Arbitrations Texas Medicine, Oct. 2023
TMA has created a draft TDI complaint letter you can customize for your patients. We have it available in both English and Spanish. Complaints about a health plan’s network may include problems locating a specialist who is accepting new patients, finding a doctor within reasonable driving distance from the patient’s home, or inaccurate information in the health plan’s provider directory.
Some surprises are fun; surprise bills aren't.
TMA has developed a one-page patient handout describing the most common reasons for "surprise" medical bills. There's also a longer document for those who want more details.
No Surprises Act Consumer Webpage (CMS)
Got questions about Surprise Bills? Call the Knowledge Center.