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Last-minute Lawsuit Filed Over Surprise Billing

— December 8, 2021

Businesses step in with lawsuit over surprise billing.

The American Medical Association (AMA), the American Hospital Association (AHA) and other plaintiffs have filed a lawsuit just before U.S. President Joe Biden’s new ban on medical billing for which a consumer is not aware.  They have indicated that lawmakers and Biden administration misread the law’s language to the injustice of medical billers.  The new suit could influence contract negotiations between insurance companies and the providers they serve, thus, affecting the price for end consumers as well.

Consumer advocacy groups, employers, insurers and those in Congress who wrote the law have supported the new billing regulation.  The measure was passed after years of it initial being written and is meant to ensure that patients don’t receive high bills.  According to studies “twenty percent of patients who visit an emergency room are treated by an out-of-network provider.”  Not only are their bills higher but the underlying issue of is that ERs are also not diligent about connecting with primary and preventive care doctors to allow patient bills to be more reasonable.

Lack of coordination is at the center.  Moreover, patients are commonly triaged and see multiple specialists when hospitalized, including vulnerable patients who have to see anesthesiologists, pathologists and radiologists in their weakest time with little to no say whether the providers they’re seeing are in network.

Last-minute Lawsuit Filed Over Surprise Billing
Photo by ohn Guccione from Pexels

Surprising billing is supposed to go into effect beginning January 1, 2022.  The law also establishes an arbitration system in which the parties can be head in front of a neutral party should there be any dispute.  The arbitration provisions led to outcries from the medical community, worried that they would be unable to take an unpaid bill.  They would also have to settle on the median price that doctors of their specialties typically make.

The new lawsuit reads, “The departments have no authority to discard Congress’s judgment that training, and experience are important considerations in determining the appropriate payment rate, even if they disagree with it.”

The Business Group on Health showed its support by stating, “A thoughtful and balanced approach to the interests of the various stakeholders.” The American Heart Association said it “will produce reliable and consistent results that do not have an inflationary impact on health care costs.”

People involved in the fight over surprise billing said they were not alarmed about the lawsuit. “There’s a lot of money at stake here, and it’s not at all surprising that the provider groups would sue in order to hold onto some of the payments they are receiving today,” said Matthew Fiedler, a fellow at the Brookings Institution.

Opponents say the law will only make consumers more likely to go to a mediator to lower fees instead of paying.  Matthew Fiedler, a fellow at the Brookings Institution, said, “predictable arbitration process could lead to fewer clinicians who are in network, as more of [must] them rely on arbiters to settle payment disputes.”

Medical personnel will need to show that the Biden administration was “arbitrary” or “capricious in its interpretation of the law or that it lacked statutory authority.”

A lawsuit says the Biden administration’s faulty interpretation of the law will harm medical providers.


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