The Texas Medical Association filed its second lawsuit Thursday challenging the federal government’s surprise billing process.
A august rule independent dispute resolution for contingent medical bills still unlawfully favors insurers over providers, the Medical Association claims in its complaint in the US District Court for the Eastern District of Texas.
“We again demand that the law be obeyed as Congress intended and that the contested provisions be void. Physicians and healthcare providers should have a level playing field in payment disputes after caring for patients,” said Texas Medical Association President Dr. Gary Floyd, in a press release.
The lawsuit comes right after the American Medical Association and the American Hospital Association dropped their legal challenges to politics. The AMA and AHA support the Texas lawsuit. “We intend to make our voice heard in this case by filing an amicus brief explaining how the final rule differs from Congress’ intention, just like the September 2021 interim final rule,” the organizations said in a joint statement on Thursday.
The Texas Medical Association first sued regulators over arbitration last year. The interim rule required the arbitrators to select the surprise bill payment offer that came closest to the median of the in-network rate contracted by the insurer. Judge Jeremy Kernodle of the US District Court for the Eastern District of Texas decided in favor of Texas doctors in February.
The federal government appealed the decision in April, but subsequently established a rule requiring arbitrators to consider both the median of an insurer’s contracted in-network rate and additional information when deciding whether to pay a surprise bill.
The Texas Medical Association claims the final rule does not go far enough to protect provider payments. The method used to calculate insurers’ median in-network rates is “deflated” compared to insurers’ actual average contract rates, the group argued in the press release.
“These provisions of the final rule are manifestly unlawful and unfairly distorted [independent dispute resolution] Results in favor of insurers, giving them a stroke of luck that they could not achieve in the legislative process. At the same time, they undermine the ability of healthcare providers to receive fair compensation for their services, to the detriment of both providers and the patients they serve,” the complaint reads.