WASHINGTON, D.C.—The American College of Emergency Physicians (ACEP) is pleased that a federal judge ruled in favor of the Texas Medical Association to find significant flaws in the No Surprises Act implementation process.
“This decision is a significant win for patients and physicians,” said Gillian Schmitz, MD, FACEP, president of ACEP. “We are optimistic that additional courts will take appropriate steps to make sure that this law can do what Congress intended it to do—protect patients from surprise bills and create a fair process to resolve billing issues.”
A federal judge in Texas ruled on Feb. 23 that the No Surprises Act implementation fails to follow the letter of the law, and that giving unequal weight to the Qualified Payment Amount (QPA) tilts the process unreasonably in favor of insurance companies. The court also determined that by skipping a customary notice and comment period while the law was being finalized, the government failed to follow its own well-established and transparent regulatory process.
The Texas Medical Association (TMA) is one of many physician and provider groups raising significant issues with the implementation of the new surprise billing law. None of the legal actions pursued by physicians seek to undo any of the patient protections.
The concerns validated by the ruling in Texas are some of those shared by ACEP, the American Society of Anesthesiologists and the American College of Radiology in a separate lawsuit currently in a Chicago district court.
“Congress wrote this law to create an unbiased system for billing dispute resolution,” said Dr. Schmitz. “Instead, the way the law is being implemented opens the door for insurance companies to narrow their networks and reduce patient access to care. It is a good sign for everyone who relies on emergency care that the Texas court clearly recognized the need for change.”