A federal judge poked at the government’s defense concerning a key mechanism that is designed to help third parties tasked with resolving payment disputes between healthcare providers and insurers.
Federal Judge Jeremy Kernodle heard arguments Tuesday in a case challenging the implementation of a federal law that protects consumers from surprise medical bills, Healthcare Dive reports.
The No Surprises Act was a win for consumers who found themselves stuck with hefty medical bills after being caught between provider and payer pricing disputes. Patients were sometimes stuck with the remaining balance of a medical bill from an out-of-network provider with insurers paying only some — or none — of the bill. Patients were sometimes surprised by these bills after going to an in-network facility and unknowingly treated by an out-of-network clinician.
The law set up a process for how payers and providers could resolve disputes by allowing parties to enter baseball-style arbitration. Unable to come to pricing terms, each side submits an offer to a third party, known as an arbiter, who is then supposed to select one offer.
At issue in these cases is the instruction given to arbiters on how to pick the most appropriate offer.
The Texas Medical Association is challenging the rule, arguing it unfairly benefits insurers by anchoring pricing decisions to the qualified payment amount, or median in-network rate for healthcare services, which is calculated by insurers. Read more.
