Sep 26, 2022 - Health

Providers hit Biden admin with new surprise billing court challenge

Illustration of an opened envelope with a billing statement inside and confetti spilling out.

Illustration: Aïda Amer/Axios

Providers are once again challenging the Biden administration on the surprise billing law and the method for deciding who picks up the tab in disputes over out-of-network care.

The big picture: Almost 10 months after the law protecting patients from unexpected medical bills took effect, key details have yet to be settled, with billions of dollars on the line for providers, insurers and employers.

Catch up quick: The Texas Medical Association last week sued in federal court over a final rule for implementing the law, saying it skews results in favor of insurers.

  • The same group successfully challenged an earlier version in court, saying it unfairly favored insurers by telling arbiters to select the rate closest to the health plans' median in-network rates for the same or similar services in the geographic region.
  • The Labor Department, the Health and Human Services Department and the IRS last month redefined the factors arbitrators have to weigh, saying they no longer have to start with that median in-network rate.

What we're watching: The court has to decide if the latest rule deprives physicians and providers of the arbitration process the law intended. Whatever the outcome, it likely will not be the final word on surprise billing.

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