AHIP backs HHS in surprise billing fight with medical groups

AHIP is backing HHS in a lawsuit over surprise billing arbitration from Texas providers, who have support from the largest associations of providers. 

The trade association filed an amicus brief in Texas Medical Association v. HHS on Nov. 16. 

The lawsuit, filed by the Texas Medical Association in September, challenges the arbitration process established under the No Surprises Act. 

The Texas Medical Association and more than 30 national and state medical groups, including the American Medical Association and American Hospital Association, signed amicus briefs in support of the suit that argues the arbitration process favors payers. 

The No Surprises Act, passed in 2020, limits how much patients can be charged for out-of-network emergency services. 

Under an interim final rule unveiled in July 2021, CMS directed the arbitrator in the independent billing dispute resolution process to assume that the qualifying payment amount, or the median in-network rate set by payers, is the appropriate out-of-network rate. 

In its brief, AHIP argues this arbitration standard does not give payers an unfair advantage. 

In a press release, the trade association said there is "no basis" to providers' claims the arbitration rates will cause payers to lower reimbursement rates and narrow networks. 

"In fact, there are early signs of a beneficial trend, where the [No Surprises Act] has furthered good faith network negotiations over reasonable rates," the association said in the release. 

Read AHIPs full statement on the lawsuit here.

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