Medical providers challenging patient-protecting No Surprises Act in court

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U.S. PIRG files amicus brief to support federal rules to keep health costs down


WASHINGTON – The newly-enacted No Surprises Act, which protects insured Americans from surprise out-of-network medical bills, is under legal attack in several courts from stakeholders who have profited from surprise medical billing. In November, the Association of Air Medical Services (AAMS) filed suit against the federal government in U.S. District Court challenging rules issued in September about how to implement the Act. The AAMS lawsuit focuses specifically on the arbitration system established to settle billing disputes between providers and insurers. On Tuesday, the U.S. Public Interest Research Group (U.S. PIRG) moved to file an amicus brief urging the court to uphold the rules, arguing that they follow the language and intent of the Act to keep health care costs down. 

“Insured Americans have waited long enough for protections against the predatory billing practices of out-of-network air ambulances. If you’re in bad enough shape to need an air ambulance, you sure as heck don’t have a way to avoid or negotiate their charges,” said Patricia Kelmar, JD, U.S. PIRG’s Health Care Campaigns Director. “Congress found a bipartisan solution to take patients out of the middle of medical billing battles and establish a reasonable payment dispute resolution system that keeps overall costs down. This is the industry’s last-ditch effort to save their biggest profit-maker: surprise billing.”    

AAMS argues that the rules issued last year by the Centers for Medicare and Medicaid Serves unfairly favor health insurers over air ambulance providers and would lead to lower payments for air ambulance services. These rules spell out guidelines for arbiters to follow when settling payment disputes between insurers and air ambulance providers. Arbiters must first consider the qualifying payment amount (QPA), which is the median amount paid to in-network air ambulance services in that geographic area. The QPA is supposed to be the central factor determining a final payment sum to the provider, with additional circumstances such as the severity of the patient’s situation or the quality of the outcome as secondary factors.

The proposed amicus brief signed by U.S. PIRG and three other nonprofits supporting the government in Association of Air Medical Services (AAMS) v. U.S. Department of Health and Human Services, et al. states: 

“Plaintiff’s mere disagreement with how the agencies weighed the factors is an insufficient

basis for challenging the September Rule as arbitrary and capricious…The September Rule, unlike Plaintiff’s preferred approach, follows the statute by requiring arbitrators to consider the QPA and other factors, and heeds Congress’ intent by encouraging health care payers and providers to negotiate, resulting in increased in-network care at more affordable rates for patients and their families.”

The brief urges the court to “grant Defendants’ Cross-Motion for Summary Judgment, deny Plaintiff’s Motion for Summary Judgment, and uphold the Rules.” The parties to this brief are represented by Joseph Wardenski of civil rights law firm Wardenski P.C.