TMA continues fight for fair process in federal surprise billing law


Soraya Marashi


The Texas Medical Association (TMA) Monday reiterated its strong opposition to a part of a federal rule that unfairly favors health insurers when directing arbiters to resolve payment disputes between insurers and physicians under the No Surprises Act.

brief filed by TMA late Monday opposes the federal agencies’ motion for summary judgment in TMA’s legal challenge to the federal rule. In the filing, TMA said the rule fails to implement the No Surprises Act the way Congress wrote it, and the consequences for patients include reduced access to care and health care consolidation. Similar concerns are shared by dozens of national and state organizations who have supported or filed challenges to the rule.

“The last thing federal regulators should do is make health care more expensive and less accessible for people when they need it, especially during a pandemic,” said TMA President E. Linda Villarreal, MD. “The courts must reject the federal agencies’ flawed approach, because it goes against the public interest and our democratic process.”

TMA’s filing also rejects the federal agencies’ claims that TMA does not have standing to pursue its case.

Congress spent years working on the No Surprises Act so it would not limit patients’ access to medical services, while protecting them from surprise medical bills. TMA filed its lawsuit on Oct. 28, 2021, challenging a flawed component of the federal rule concerning payment dispute resolution.

Under the rule, arbiters conducting the payment dispute resolutions are required to rebuttably presume that the “qualifying payment amount” (an amount that is supposed to be the median in-network rate under the law but is deflated based upon the federal agencies’ methodology) is the appropriate out-of-network rate. TMA’s lawsuit asks the court to strike the rebuttable presumption provision of the rule in order to align the rule with the law, which directs arbiters to consider a range of relevant factors. Oral arguments are set for Feb. 4, 2022. TMA’s lawsuit does not delay or seek to change the No Surprises Act’s patient protections from surprise medical bills, which have already gone into effect.

This press release was provided by the Texas Medical Association.