The Physician Advocacy Institute (PAI), American Association of Neurosurgeons (AANS), and Congress of Neurosurgeons (CNS) join 16 state medical associations and 7 national medical societies to prohibit formal support for the American Medical Association (AMA) and the American Hospital Association the (aha) A lawsuit filed last December against the Department of Health and Human Services. The coalition filed an amicus brief last week against the No Surprise Act (NSA) dispute resolution guidelines.
Notably, the coalition’s amicus briefs strongly support the NSA’s protection of patients, as in the original lawsuit. Like the lawsuit, the amicus brief objected to how the current interpretation relies on the median in-network billing rate determined by insurers themselves, rather than the numerous factors originally required by law, to resolve billing disputes. The amicus brief cited failure to take into account several factors originally required by the law, giving insurers an unfair advantage.
The No Surprise Act (NSA) went into effect Jan. 1 and limits the amount patients can pay out-of-pocket for out-of-network services and providers. For example, if a patient needs emergency services in the emergency room, the provider that is available may not be in the network, or the lab that performs the tests in the emergency room may not be covered by the patient’s insurance network. As a result, the NSA, in an effort to protect patients from overpaying bills, requires insurance to charge patients only the median in-network billing rate, even out-of-network, using multiple factors.
However, some groups have disputed guidelines issued by federal regulators on determining in-network rates that apply to out-of-network services. In particular, the lawsuit and Friends of Support brief filed last December specifically raised questions about how the rule would allow insurers to use a self-determined median in-network billing rate in the event of a dispute. Proponents of the lawsuit argue that the rule unfairly gives insurers leverage to influence the resolution of disputes, allowing them to focus on this item rather than the several holistic factors required in the original bill.
Specifically, the lawsuit and the amicus brief argued that the guidance would unfairly lower the amount providers end up getting.
“Physicians have an obligation to highlight to the court the extent to which federal regulators have strayed from the No Accidents Act’s balanced approach to payment disputes, and to explain how bypassing the law would unfairly empower insurers to the detriment of patients and their physicians. ,” said Dustin Corcoran, PAI president and CEO of the California Medical Association, speaking at a news conference.
The following groups supported the amicus brief: American Society of Neurosurgeons, American Academy of Orthopaedic Surgeons, American Society of Hematology, California Medical Association, Michigan Medical Association, Texas Medical Association, and Washington State Medical Association, among others.
“This deeply flawed statute represents an approach Congress has refuted as it recognizes that failure to consider multiple factors before deciding on payment disputes will make it harder for patients to seek medical care, especially specialty care,” John K. Ratliff said Dr. Stanford, a practicing neurosurgeon at Stanford University and chair of the AANS/CNS Washington Committee, in a press release.
The coming months will show how insurers resolve disputes in practice, and how these decisions ultimately affect providers’ bottom lines.
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