The No Surprises Act, which went into effect on Jan. 1, bans surprise medical bills for out-of-network care and establishes a process for resolving payment disputes between health plans and providers. Unfortunately, the final rule implementing the law continues to give preference to the qualifying payment amount — or median in-network rate — which unfairly favors insurers when settling out-of-network payment disputes. When resolving payment disputes, the law requires arbiters to consider several factors equally — not just median in-network rates — including the physician’s training and experience, the severity of the patient’s medical condition, prior contracting history, health plan market share and other relevant information.
On Oct. 19, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) spearheaded a physician-led amicus brief, along with the Physician Advocacy Institute, supporting the Texas Medical Association’s (TMA) new lawsuit challenging these rules. Other medical groups, including the American Medical Association, also filed amicus briefs supporting the TMA lawsuit.
Click here to read neurosurgery’s amicus brief and here for the accompanying press release.
