TMA Moves for Victory in Challenge to Unfair Arbitration Rule

Dec. 13, 2021

District court filing urges remedy to federal rule that would reduce patient access to physicians

AUSTIN—The Texas Medical Association (TMA) today announced it has filed a motion for summary judgment in its lawsuit in the U.S. District Court for the Eastern District of Texas.

The motion asks the court to decide, without a trial, that the U.S. departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management failed to follow clear direction from Congress about how to implement the physician-insurance company dispute resolution process set forth in the No Surprises Act, legislation passed in 2020 to address surprise medical bills.

“Congress worked hard to pass a law that protects patients from surprise medical bills, and Texas physicians are very supportive of the patient protection intent of that law. However, we are deeply concerned that the statutory process for settling billing disputes between physicians and insurance companies has been significantly altered, skewing the process in favor of insurance companies,” TMA President E. Linda Villarreal, MD, said.

“Congress made clear that an arbiter must consider a multitude of factors before resolving a dispute under the No Surprises Act, in the interest of fairness. Federal regulators are abandoning the law and giving insurance companies an early holiday present. If the government is allowed to implement this unfair rule, the very health care system that patients now rely upon will be threatened, while they have less access to physicians,” Dr. Villarreal said.

The No Surprises Act channels payment disputes between physicians and insurance companies through an independent, third-party arbiter and specifies that several factors - including but not limited to median in-network rates - must be taken into account. These additional factors include prior contracted rates for the medical service, the physician’s training and experience, the patient’s acuity, and the facility’s case mix and teaching status, among others. These other factors are important under the law in determining fair and reasonable rates of payment for clinical care to patients.

Failing to follow the No Surprises Act’s billing dispute approach will make it harder for patients to access care by driving down payment rates to physicians and encouraging insurance companies to continue narrowing their networks, according to TMA experts and numerous national physician groups.

“When insurers allow fewer and fewer physicians to join their networks, patients end up with less choice,” Dr. Villarreal said. “It will be difficult for small physician groups to keep caring for patients.”

TMA filed a lawsuit in U.S. District Court on Oct. 28 to restore the fair, balanced dispute resolution process that Congress created under the No Surprises Act, without jeopardizing the law’s important patient protections.

 The lawsuit also alleges a procedural violation of the Administrative Procedure Act, which requires a public notice and comment period in advance of finalizing such a rule. The agencies failed to solicit and incorporate comments from stakeholders for this crucial aspect of the law.

TMA is the largest state medical society in the nation, representing more than 55,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.


TMA Contacts:  Brent Annear (512) 370-1381; cell: (512) 656-7320

Connect with TMA on Twitter, Facebook, and Instagram.


Last Updated On

January 14, 2022

Originally Published On

December 13, 2021

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