AMA, AHA lawsuits call for update, repeal of No Surprises Act dispute provision

Both the American Medical Association and the American Hospital Association filed independent legal motions that implore the federal government to halt the rollout of the No Surprises Act's billing dispute provision.

The advocacy groups co-filed a lawsuit against HHS over the provision in December 2021. In it, they argued that the billing dispute rule was an improper interpretation of the act and encourages payers to narrow networks and lowball providers, thereby increasing profits.

"It is not the law that Congress passed," the motions say. "Agencies cannot rewrite statutes by adding material terms found nowhere in the text. … The departments' interpretation of the [No Surprises] Act is contrary to its text, design, history and intent, and is therefore owed no deference."  

Specifically, the groups fear that regulators have over-emphasized the qualifying payment amount — the median rate paid to in-network providers — to determine a fair price. According to their lawsuit, this puts far too much power in the hands of insurers, who largely dictate the qualifying payment amount. 

The organizations say North Carolina is already experiencing this problem, with Blue Cross Blue Shield North Carolina threatening to end agreements with physicians and hospitals that do not agree to lower rates, according to a Feb. 15 AMA news release.

The Texas Medical Association similarly sued HHS over the dispute resolution rule. Payer advocates, including America's Health Insurance Plans and the Blue Cross Blue Shield Association, have stepped in, issuing amicus briefs in support of the federal government and the provision.

Regulators have until Feb. 18 to respond to the pair of motions.

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