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 a No Suprises Act toolkit. TMA also offers an updated list of resources on the new law.
First, the state of Texas made its move. Then, federal lawmakers followed suit. And come 2022 – one way or another – a major transformation will be complete.
The Texas Medical Association has updated its white paper on Texas’ law for settling out-of-network billing disputes involving state-regulated health plans.
Pressure is mounting on federal authorities with multiple legal actions, including TMA's, 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.
TMA has sued federal authorities over rulemaking for the federal surprise billing law, saying it failed to follow clear direction from Congress about how to implement the dispute resolution process meant to determine fair payments for out-of-network care.
Check out these TMA research papers on charges, insurance company contracting, and insurance company networks.
Resources Concerning the No Surprises Act
The Real Truth About Surprise Bills
Physician Charges Do Have Meaning
How to Appeal Being Dropped From a Network
Physician Prices, Fee Schedules, and Managed Care Contract Offer and Acceptance
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.
Get the Latest Surprise Bills Information Here
Got questions about Surprise Bills? Call the Knowledge Center.