The Texas Medical Association sued the Biden administration in October over what it claims was the improper implementation of a billing dispute resolution process under HHS. Specifically, the lawsuit alleges the current resolution process — which assumes that the qualifying payment amount is the appropriate out-of-network rate — does not reflect Congress’ intent in passing the act.
The group claimed the process “creates a bias that prioritizes offers closest to the QPA, rather than allowing arbitrators to exercise their discretion to weigh all relevant factors and select the reimbursement rate that most accurately reflects fair market reimbursement and individual circumstances.”
Both AHIP and the Blue Cross Blue Shield Association independently filed briefs that support HHS’ legal argument.
In a Jan. 18 news release, AHIP said that the current qualifying payment amount represented “competitive, fair market rates,” and that the lawsuit seeks to “create the very problems the Act aims to remedy.”
Similarly, the Blue Cross Blue Shield Association stated its support for HHS’s stance, claiming the current application is the best way to protect patient interests.
“The IFR reflects the Departments’ diligent efforts to faithfully implement the intent of Congress when it sought to end so-called ‘surprise billing,'” the Blue Cross Blue Shield Association said in a news release. “In the Act, Congress carefully considered the interests of health care providers, payors, and above all, patients. It balanced those interests in designing an IDR process pegged to the QPA.”
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