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TexPIRG expresses frustration with doctors’ lawsuit that could delay implementation of surprise billing protections

Advocates say tying out-of-network payments to local in-network rates ensures fair payment and keeps consumer costs down
For Immediate Release

AUSTIN - Today the Texas Medical Association filed a complaint in the U.S. District Court for the Eastern District of Texas to put a stop to newly proposed rules regarding implementation of the No Surprises Act. The No Surprises Act will go into effect January 1, 2022, and is lauded as a landmark consumer law to protect millions of Americans from most unfair surprise medical bills from out-of-network providers. These surprise bills come from balance billing -- when out-of-network medical professionals charge patients the difference between their fees and the maximum amount allowed by their insurance company. Studies show one in five patients are hit with a surprise medical bill after receiving care in a hospital or emergency room

On September 30, 2021, the U.S. Departments of Health and Human Services, Treasury and Labor released interim final rules that deal primarily with how to settle payment disputes between out-of-network providers and insurers. The law establishes an arbitration system and sets guidelines for arbiters to primarily consider the average in-network rate, dubbed the “qualified payment amount,” in making their decisions for payment awards. The Texas Medical Association lawsuit claims the new rules set up an arbitration process where insurers get a “windfall” and makes it difficult for providers to receive fair payment for their out-of-network services. 

In response to the lawsuit, Patricia Kelmar,TexPIRG’s Health Care Campaigns director, who will speak about surprise medical bills at the Texas Covered Conference next month, made the following statement:

“We’re frustrated that providers are filing this suit to halt important rules that will enable the No Surprises Act to work effectively to protect patients from surprise medical bills. This lawsuit could delay our long-awaited consumer protections, meaning we’ll still be saddled with expensive and unfair out-of-network charges we have no way to avoid.

“The proposed rules don’t take away the providers’ ability to be adequately compensated. The law keeps payments reasonable by tying them to local in-network negotiated rates - meaning providers still get paid fairly, and consumers won’t bear the burden of costs shifted to our premiums when providers lose outlier lottery-sized payment demands.”

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TexPIRG (Public Interest Research Group) Education Fund is an independent, non-partisan group that works for consumers and the public interest. TexPIRG Education Fund is part of The Public Interest Network, which operates and supports organizations committed to a shared vision of a better world and a strategic approach to getting things done.Through research, public education and outreach, we serve as counterweights to the influence of powerful special interests that threaten our health, safety or well-being.

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TexPIRG Education Fund is part of The Public Interest Network, which operates and supports organizations committed to a shared vision of a better world and a strategic approach to social change.