Texas group's latest No Surprises Act lawsuit challenges 600% fee hike

The Texas Medical Association has filed its fourth lawsuit against the federal No Surprises Act, this time challenging a 600 percent hike in administrative fees when seeking dispute resolutions. 

The latest lawsuit argues that the fee hike will restrict many physicians' ability to seek arbitration when an insurer offers insufficient payment for care, according to a Jan. 31 TMA news release. 

Federal agencies announced in October the administrative fees would remain $50 in 2023, according to the release. Two months later, the agencies announced the fee would increase to $350 beginning in January 2023 "due to supplemental data analysis and increasing expenditures in carrying out the federal [independent dispute resolution] process since the development of the prior 2023 guidance."

"The problem is that many payment disputes in these cases amount to less than the fees physicians would have to pay to dispute the unfair payments," TMA President Gary Floyd, MD, said in a statement. "Why would doctors and providers pay the $350 nonrefundable administrative fee to arbitrate a $200 or so payment dispute with a health insurer? The fees deny physicians the ability to formally seek fair payment for taking care of our patients, and that's just wrong."

The TMA is also disputing interim final rules that narrow the No Surprises Act's stipulations on "batching" claims for arbitration, which it said Congress authorized to encourage efficiency and minimize costs in the independent dispute resolution process, according to the release. 

The TMA filed its first No Surprises Act lawsuit in October 2021, successfully arguing that requiring arbitrators to heavily weigh figures created by insurers conflicted with the law and provided insurers with an unfair advantage unintended by Congress. 

The group filed a second lawsuit in September, arguing the final rule will "unfairly advantage health insurers by requiring arbitrators to give outsized weight or consideration to the [qualifying payment amount]." A hearing in that case was held Dec. 20. The court's ruling on that case is "anticipated at any time," according to the release.  

It filed its third lawsuit in November, alleging portions of the rule "artificially deflate the qualifying payment amount." No hearing date has been set in that case, according to the release.

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