Dec. 13, 2021
court filing urges remedy to federal rule that would reduce patient access to
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.
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
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.
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
“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
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
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