LifeNet filed the lawsuit April 27 in the Eastern District of Texas federal court. That court is the same venue where a federal judge sided with the Texas Medical Association in a lawsuit over the law’s surprise billing resolution process.
In the Texas Medical Association case, the providers took issue with a portion of the process that assumes the qualifying payment amount, which is the median in-network rate set by health insurers, is the appropriate out-of-network rate. The association claimed the reliance on the qualifying payment amount does not allow arbitrators to exercise discretion and weigh other relevant factors.
Presiding Judge Jeremy Kernodle ruled in the association’s favor in February, saying the rule “places its thumb on the scale” for the qualifying payment amount. HHS filed a notice of appeal April 22.
LifeNet argues that, despite the court’s ruling, HHS continues to apply the qualifying payment presumption to air ambulance providers, according to the lawsuit. The company alleges HHS is relying on one sentence that was not expressly struck down in the Texas Medical Association case. LifeNet is asking the court to vacate that remaining sentence for the same reasons as in the earlier case.
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