Medical Groups Sue Over Implementation of Surprise Billing Rule

On Wednesday a case was filed in the District of Illinois by the American Society of Anesthesiologists, the American College of Emergency Physicians, and the American College of Radiology against the Departments of Health and Human Services, the Treasury, and Labor, as well as the Office of Personnel Management, and the . The case is regarding the implementation of anti-surprise billing legislation through an interim final rule.

The No Surprise Billing Act “addresses two interrelated problems with the private health insurance market:  1) insurers demand unreasonably low reimbursement rates as a condition of physicians participating in their networks, thus forcing many physicians to stay out of network to remain economically viable; and 2) patients who unknowingly receive certain care from out-of-network providers are responsible for amounts not paid by their insurance companies, which is known as ‘surprise billing.’”

The plaintiffs argue that the October interim final rule runs contrary to the intent of the act and also violates the Administrative Procedures Act (APA).

Specifically, the plaintiffs argue that the October rule improperly gives presumptive weight to the qualifying payment amount or amount proposed by the insurance company for payment of the out-of-network bills. This plaintiffs presumption would eliminate all of the other factors that congress provided for consideration of the payment, including the necessity of the service, availability of in network providers, and other factors that were included to provide a balancing perspective as to the amount of the bill and the amount that should be covered by insurance. The plaintiffs argue that this runs directly contrary to the intent of the act, and also qualifies as a major change in current regulations which requires a notice and comment period and cannot be approved and implemented as a regulation without that longer process.

The plaintiffs are suing for injunctive and declaratory relief that the actions of the Departments are capricious and run contrary to the No Surprise Billing Act. They are represented by Powers Pyles Sutter & Verville, PC.