Surprise Billing

TMA Considers Next Steps in Split Victory Over Payment Calculations in Surprise-Billing Arbitrations - 11/15/2024

After winning half the battle when the federal government dropped its appeal of two major components of the Texas Medical Association’s lawsuit early on, TMA is considering next steps after an appeals court upheld a portion of federal rules governing qualifying payment amount calculations in surprise-billing disputes that medicine says conflict with federal law and unfairly favor health plans.

TMA Applauds Appeals Court’s Ruling in Physicians’, Patients’ Favor - 08/06/2024

Statement by G. Ray Callas, MD, TMA president, in response to the U.S Court of Appeals for the Fifth Circuit’s ruling Friday in TMA’s favor. The court affirmed the district court’s decision in an appeal filed by several federal government agencies to TMA’s earlier victory in a lawsuit challenging certain components of the federal agencies’ final rules governing independent dispute resolution for surprise medical bills under the No Surprises Act. TMA argued the case in December 2022 in the U.S. District Court for the Eastern District of Texas. The district court later ruled in TMA’s favor, prompting the federal government appeal.

TMA Wins Appeal Upholding Its Challenge to Skewed Federal Surprise Billing Rule - 08/05/2024

A federal appeals court handed a victory to medicine affirming the district court’s decision to strike down federal provisions that run counter to Congress' intent for implementing a key piece of the No Surprises Act: to operate an arbitration process that does not skew dispute resolutions and unfairly advantage health plans. Read more.

TMA Spotlights Access Threats Posed by No Surprises Act to House Committee - 07/31/2024

Following a recent congressional field hearing on emergency care in rural and underserved communities, the Texas Medical Association emphasized in written comments how federal regulators’ flawed implementation of the No Surprises Act has exacerbated access challenges.

Seeking Balance: TMA Opposes Feds' Implementation of the No Surprises Act - 04/09/2024

The Texas Medical Association supported the patient protections in the federal No Surprises Act but also knew from the beginning that the law's payment arbitration provisions were flawed and could give insurers an advantage.

Feds Capitulate to Some of TMA’s NSA Regulatory Challenges Amid Appeal - 03/06/2024

Although federal regulators are appealing a recent court ruling in one of the Texas Medical Association’s four lawsuits regarding their implementation of the No Surprises Act, TMA already can declare a partial victory – via footnote.

New Federal IDR Data Highlight Importance of Ongoing TMA Advocacy - 03/05/2024

Health professionals and facilities are prevailing in most out-of-network payment disputes resolved under the federal No Surprises Act, but the implementation of the law remains flawed, as indicated by a significant backlog of unresolved disputes and other issues.

Extensions to End for Dispute Resolution Process Under No Surprises Act - 03/01/2024

After courtroom advocacy by the Texas Medical Association, physicians seeking to resolve out-of-network billing disputes under the No Surprises Act (NSA) received extensions of certain deadlines within the federal independent dispute resolution process. However, all currently applicable extensions will end March 14.

Feds Propose Dispute Resolution Changes Under No Surprises Act - 01/22/2024

Heeding physician concerns about logistics and fairness, federal regulators recently proposed a series of changes to the independent dispute resolution process through which clinicians can dispute health plans’ initial payment for certain out-of-network care under the No Surprises Act.

Feds Extend Dispute Resolution Timelines Under No Surprises Act - 12/08/2023

As a byproduct of ongoing advocacy by the Texas Medical Association, physicians seeking to resolve out-of-network billing disputes under the flawed No Surprises Act may receive certain extensions through mid-January.

Misdirected: Health Plan Directories See Damaging Gaps Awaiting Final Rules - 12/04/2023

Health plan directories see damaging gaps while awaiting No Surprises Act final directory rules – and accountability.

No Surprises Act Arbitrations Resume for Some Claims - 10/11/2023

The Centers for Medicare & Medicaid Services has reopened the independent dispute resolution portal for new single and bundled – but not batched – claims, following decisions in TMA’s third and fourth lawsuits. The agency also announced certain deadline and enforcement extensions.

U.S. House Committee Spotlights TMA Leadership on Surprise-Billing Rules - 10/11/2023

As members of the U.S. House Committee on Ways & Means delved into the flawed implementation of the federal No Surprises Act in a recent hearing, discussion – and commendation – turned several times to the Texas Medical Association’s leadership on the topic.

TMA Wins Two More Surprise Billing Lawsuits; CMS Suspends Arbitrations - 10/03/2023

Marking a fourth victory for the Texas Medical Association in as many lawsuits, a court on Aug. 24 struck down a large portion of the regulations setting forth a methodology insurers use to calculate the qualifying payment amount, or QPA, used in surprise-billing disputes – part of a series of federal rules TMA has long argued skew the arbitration process in insurers’ favor.

TMA Wins Fourth Lawsuit Challenging Payment Calculations in Surprise Billing Arbitration - 08/28/2023

Marking a fourth victory for the Texas Medical Association in as many lawsuits, a court struck down a large portion of the regulations setting forth a methodology insurers use to calculate the qualifying payment amount, or QPA, used in surprise-billing disputes – part of a series of federal rules TMA has long argued skew the arbitration process in insurers’ favor.

Court Delivers TMA Win Against Fee Hike, Batching in Surprise Billing Arbitration - 08/10/2023

The court struck down a 600% administrative fee increase and certain unfair rules that narrowed the law’s provisions on combining or “batching” surprise-billing arbitration claims. The decision is one of several victories TMA has won against federal regulators tasked with implementing the federal No Surprises Act.

TMA Opposes Congressional Proposal to Cap Office-Based Physician Pay - 08/07/2023

A recently filed federal bill would recycle a controversial formula that TMA has waged several lawsuits against in the federal surprise billing regulatory context to limit payments for health care services furnished in physician offices.

New TMA Lawsuit Challenges Big Fee Hike in “No Surprises Act” Arbitration - 08/04/2023

The Texas Medical Association (TMA) is challenging a 600% hike in administrative fees for seeking federal dispute resolution in No Surprises Act (NSA) situations. TMA seeks relief by filing a fourth lawsuit in the U.S. District Court for the Eastern District of Texas.

TMA Offers Remedies to Ease Surprise Billing - 06/28/2023

Texas patients sometimes feel the pain from unexpected out-of-pocket costs not covered by their health insurance, known as “surprise billing” or “balance billing.” The Texas Medical Association (TMA) is taking aim at the problem, which occurs when a health insurance company pays less than what a doctor charges, leaving the patient to pay the balance of the bill.

Physician-Led Results: Network Adequacy and Protecting Texas’ Surprise-Billing Law - 06/22/2023

Physicians’ ongoing struggles with health plan contracting galvanized TMA to champion network adequacy reform at the Texas Capitol. The regular session wrapped up with the unanimous passage of House Bill 3359, which cements the state’s network adequacy rules and strengthens insurers’ accountability under them.

Update: TMA Pushes for Compliance With Second Surprise-Billing Win Amid Backlog of Payment Disputes - 03/24/2023

Amid much wrangling with federal regulators, the Texas Medical Association is taking steps to hold them accountable for complying with TMA’s second legal victory nullifying certain rules governing out-of-network payment disputes under the No Surprises Act.

UPDATE: TMA Sues Feds – Again – Over Unfair Arbitration Process Under Federal Surprise Billing Rule - 02/10/2023

The Texas Medical Association is back in court – again – to hold federal regulators accountable for implementing a key piece of the No Surprises Act as Congress intended it: to operate an arbitration process that does not skew the dispute resolution process in favor of health plans.

Legislative Priority #9: Network Adequacy, Surprise Billing - 02/10/2023

The Texas Medical Association wants to see enhanced enforcement of and accountability under state network adequacy laws and to protect Texas' surprising-billing law during the 2023 legislative session.

Feds Delay Portion of “Good Faith Estimate” Requirements Under Surprise Billing Law - 02/10/2023

Despite ongoing litigation over certain aspects of the federal surprise billing law, many of the patient protection components of the No Surprises Act still took effect in 2022. However, enforcement of a price transparency measure slated for Jan. 1, 2023, has been delayed indefinitely, giving physician practices more time to prepare.

TMA Seeks to Protect Patients’ Access to Care in New “No Surprises Act” Rules Lawsuit - 02/10/2023

Amid concerns about threats to patients’ access to physicians’ care, the Texas Medical Association has filed a new lawsuit in the U.S. District Court for the Eastern District of Texas, challenging certain portions of the July 2021 interim final rules implementing the federal No Surprises Act. This is the third lawsuit TMA has filed against federal agencies related to rulemaking under the law.