The American College of Emergency Physicians and the American College of Radiology (ACR) brought a lawsuit against federal government. The lawsuit claimed that the interim final ruling (IFR), on surprise medical billing, goes against the No Surprises Act language and will ultimately hurt patients and access to care.
The No Surprises Act was passed in December 2020. It was created to protect patients against unexpected out-of-network charges. The law was intended to settle payment disputes through an impartial arbitration process. However, the Departments of Health and Human Services, Labor, and Treasury released the interim final rule. This allows profit-seeking insurers to empower local physician practices, reduce provider networks, and limit access to care.
According to ACEP and ACR, the recent rule disregards the law’s intent for fair, independent dispute resolution (IDR). The law passed directs the arbiter to consider all information provided by the doctor and insurer, including the median rate in-network, case complexity, rates previously contracted and market power of both the physician, and the insurance company.
According to the law, the QPA (qualified payment amount) can be considered as one of many equally weighed factors in dispute resolution. The QPA, an unverified rate that was set by the insurers, was made the primary factor in the IDR process by the departments. This artificially lowers the benchmark payment for all care, in network or out, which could limit access to care, especially in areas that are underserved.
We strongly support the law’s patient protections. Instead of increasing in-network access for patient, this rule does exactly the same thing we explained to Congress. Insurance companies will use their vast market power and these flawed regulations to push more doctors out of network and fatten them,” stated Randall M. Clark M.D., FASA. “If these rules don’t get overturned or changed, insurance companies will resort to strong-arm tactics to misuse these laws, as we saw in North Carolina. This could lead to severe disruptions and loss of care for patients who really need it.
“It is extremely troubling that the administration would change the carefully balanced mechanism for resolving billing disputes established by Congress under the No Surprises Act. The law we have is a tilting of market forces in favor for insurers. They are already using their new incentive to drive emergency physicians out of the network. Gillian Schmitz M.D. FACEP president of ACEP said that legal remedy is needed to ensure that the IFR doesn’t undermine the entire dispute resolution process.”
Many practices are feeling the economic effects of the pandemic. The cost of imaging has fallen over the past few years, including 2020. Insurers are now using the new law as a way to increase their profits, cutting reimbursement to a level that many providers cannot absorb and becoming unable to stay in their network,” Howard B. Fleishon M.D., FACR, chairman of the American College of Radiology Board of Chancellors, said. This insurer overreach could lead to longer wait times, delayed diagnosis, higher out-of-pocket costs, even death, as insurers use the new law against patients to deny them access to their preferred providers. We have no choice but to defend patient access to care with legal action, as this dangerous regulation will take effect on January 1.
This lawsuit will not affect No Surprises Act protections to keep patients harmless during out-of network payment disputes between insurers and providers. It will also not increase out-of pocket costs for patients. Today, the lawsuit was filed in Chicago’s federal district court.
The American College of Emergency Physicians is the national medical society that represents emergency medicine. ACEP is the national medical society representing emergency medicine. It promotes emergency care for its 40,000 members and more than 150 million Americans that they treat annually through continuing education, advocacy, research, education and public education. For more information, visit www.acep.org and www.emergencyphysicians.org.
The American Society of Anesthesiologists was founded in 1905. It is an educational, scientific, and research society that has more than 55,000 members. Its purpose is to maintain and raise the standards of medical anesthesiology. ASA is committed in ensuring that physician anesthesiologists monitor and evaluate patients prior, during, and after surgery. This ensures the best possible care for every patient. The American Society of Anesthesiologists is available online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Follow ASALifeline Twitter and like ASA on FB.
The American College of Radiology (ACR) was founded in 1924. It is a medical society that serves patients and society.