No Surprises Act Rules: Updates and Future Considerations

The AMA/AHA Lawsuit

The American Medical Association (AMA) and the American Hospital Association (AHA) have filed suit in the district court for the District of Columbia against the federal government over the No Surprises Act’s billing dispute resolution.

The suit argues that the plan ignores statutory language and would result in reduced access to care for patients. The lawsuit is narrowly focused on the resolution process, says the AMA in a press release, and would not prevent the law’s core patient protections from moving forward, including limitations to out-of-pocket costs for patients. According to the AMA and AHA, the resolution process outlined in the September 2021 interim rule would lessen insurers’ incentives for negotiating fair contracts, and the AMA predicts that fewer insurance contracts will be offered because of it.

The AMA/AHA lawsuit notes that this scenario is already occurring in North Carolina. According to the AMA, the dominant insurer in the commercial market there, Blue Cross Blue Shield North Carolina, has threatened to terminate agreements with physicians and hospitals who do not agree to lower rates in light of the new rule.

“Congress established important patient protections against unanticipated medical bills in the No Surprises Act, and physicians were a critical part of the legislative solution,” said AMA president Gerald E. Harmon, MD, in the press release. “Our legal challenge urges regulators to ensure the meaningful process to resolve disputes between healthcare providers and insurance companies created by Congress is realized.”