Bloomberg recently highlighted how certain providers seek to increase health care costs for patients by challenging current rules regarding the independent dispute resolution (IDR) process. The No Surprises Act created regulations preventing providers from charging patients for out-of-network care, however the Texas Medical Association and other entities have continued their fight to dismantle these patient focused rules.

Legal challenges to the No Surprises Act threaten patient protections and cost savings measures which were created to ensure affordable, accessible health care for patients. While 9 million surprise bills have already been prevented from reaching patients thanks to the No Surprises Act, certain providers continue their efforts to weaken the protections written into the law by increasing costs and complicating the role of IDR entities.

In the article, AHIP’s Adam Beck says it best, “The No Surprises Act is working for patients. It’s just not working for private equity. That’s why you’ve seen this aggressive litigation strategy.” It is essential that the Administration stand firm in their efforts to implement the law as written and protect patients from unwarranted and unfair surprise medical bills.

Read the full article here and see below for key quotes.

  • “‘The plaintiffs in Med. Ass’n v US Dept of Health and Human Services in the US District Court for the Eastern District of Texas “are seeking higher reimbursement’ in the independent dispute resolution process created under the No Surprises Act, Kinika Young, director of legal advocacy for the Leukemia & Lymphoma Society.”
  • “The No Surprises Act requires arbitrators to consider the qualifying payment amount, the median in-network rate, among other factors in resolving the payment disputes.”
  • “The qualifying payment amount is the basis for calculating how much patients pay through cost-sharing amount, Young said. ‘Increasing the QPA, as the plaintiffs seek to do, would mean increasing the patient cost-sharing amount,’ she said.”
  • “The No Surprises Act was intended to protect consumers from surprise bills and to lower health-care costs by reducing incentives for providers to stay out of network, Katy Johnson, senior counsel for health policy with the American Benefits Council, said in the press briefing.”
  • “‘The No Surprises Act is working for patients. It’s just not working for private equity,’ Beck said. ‘That’s why you’ve seen this aggressive litigation strategy.’”