The American Medical Association and American Hospital Association have filed a lawsuit against the federal government seeking to stop the enactment of the No Surprises Act, which is scheduled to go into effect on January 1. The groups, joined by a number of other healthcare providers, are trying to block the process through which payers and providers would resolve disputes over the cost of medical treatments.
Under the law, patients are only responsible for their in-network cost-sharing responsibilities, such as co-payments and deductibles, while insurance companies and healthcare providers are required to negotiate the remaining unpaid portions of medical bills. About 20% of individuals who visit emergency rooms are likely to receive surprise medical bills, because they are either sometimes treated by doctors who are not part of the hospital’s insurance network or because the patient was taken to a facility that is not part of his or her health plan.
Surprise billing is important to the accounts receivable management industry because one-in-10 surprise medical bills are for at least $400, a financial threshold that many consumers find too much to be able to afford, according to studies and reports.
The suit takes aim at the dispute resolution process, which would require an arbitrator to hear both sides and render a decision on which side’s price should be honored. The suit argues that the arbitration process places an undue emphasis on the Qualifying Payment Amount — a payer’s median of contracted rates for specific services in a given geographic area. The plaintiffs argue that the dispute resolution process is contrary to the “deliberate compromise” that Congress sought when it passed the bill into law.
“No patient should fear receiving a surprise medical bill,” said Rick Pollack, Chief Executive Officer of the AHA, according to a published report. “That is why hospitals and health systems supported the No Surprises Act to protect patients and keep them out of the middle of disputes between providers and insurers. Congress carefully crafted the law with a balanced, patient-friendly approach and it should be implemented as intended.”
