Under the No Surprises Act (NSA), physicians and insurers can use an independent dispute resolution process to determine the payment amount for services. The process was intended to keep patients out of the middle of these billing disputes. Unfortunately, the final rule implementing the law unfairly favors insurers when settling out-of-network payment disputes. Last year, the AANS and the CNS spearheaded an amicus brief supporting a lawsuit filed in Texas challenging these rules. Earlier this year, the Texas court ruled in favor of physicians, and the Biden Administration has notified the court it intends to appeal this decision.
Another lawsuit challenging the NSA is also making its way through the courts, and the AANS and the CNS are leading another amicus brief. In Haller v. U.S. Dep’t of Health & Human Servs., Dr. Haller argued that the NSA violates the U.S. Constitution’s Seventh Amendment (right to trial by jury in federal court for certain civil disputes). The U.S. District Court for the Eastern District of New York disagreed, determining that providers could only resolve out-of-network billing disputes through the NSA’s process. The AANS and the CNS disagree with this interpretation of the law and filed an amicus brief asking the court to affirm that the NSA does not interfere with a physician’s right to pursue all available legal remedies, including litigation, to obtain fair reimbursement from insurers. Simply put, the NSA “does not replace providers’ common-law claims and merely offers a voluntary alternative to civil litigation.”
Insurers are weaponizing the NSA to slash both in-network and out-of-network physician reimbursement. The AANS and the CNS will continue to advocate that neurosurgeons are fairly compensated, including advocacy efforts to implement the NSA as Congress intended.
Click here to read the amicus brief in the Haller case.
