Texas Medical Association files fourth lawsuit against federal No Surprises Act


Boram Kim


The Texas Medical Association (TMA) announced on Tuesday that it has filed a lawsuit in US District Court challenging a 600% increase in administrative fees related to the federal independent dispute resolution (IDR) process for out-of-network medical claims. 


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Federal agencies announced last month the fee would increase from $50 to $350 beginning in 2023 because of “increasing expenditures” in administering IDR. With the latest hike, TMA said the fee restricts physicians’ ability to seek arbitration in cases of insufficient payment by payers for care rendered. 

“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.”

It marks TMA’s fourth legal action against the federal No Surprises Act (NSA) and its arbitration process. TMA has been at odds with the US Department of Health and Human Services (HHS) over the government’s arbitration process between payers and providers. 

Its previous lawsuit filed in November alleges portions of the Biden administration’s final rules concerning IDR “artificially deflate the qualifying payment amount” (QPA). A court date has yet to be announced in that case. TMA also claims the interim final rules narrow NSA stipulations on “batching” claims for arbitration, which Congress authorized to encourage efficiency and minimize costs.

Two of its earlier lawsuits allege that the current IDR process unfairly favors insurers. TMA won its first lawsuit filed in 2021 at the district court level, yet its second ongoing lawsuit filed last September against the final rules maintains the process continues to give outsized weight or consideration to QPA.