Congress passed the No Surprises Act to address surprise medical bills, allowing for a 30-day negotiation period between health providers and insurers, followed by arbitration if disputes arise. The Biden administration released regulations implementing the law, drawing criticism from 152 lawmakers who argue that it favors insurers over providers and doesn't align with the legislation's intent. The proposed rule requires arbitrators to start with the median rate paid to in-network providers as the qualifying payment amount, which opponents argue could push prices too low and harm networks, especially in rural areas. A lawsuit filed by the Texas Medical Association against the Biden administration contends that similar rules in states like California have led to lower payment rates and could incentivize insurers to end contracts with better-paid providers. Click here for article.
Congress passed the No Surprises Act to address surprise medical bills, but regulations proposed by the Biden administration have drawn criticism from 152 lawmakers for favoring insurers and deviating from the law's intent.
The proposed rule requires arbitrators to start with the median rate paid to in-network providers, potentially leading to lower payment rates and harm to networks, particularly in rural areas.
A lawsuit filed by the Texas Medical Association argues that rules similar to those proposed by the Biden administration in states like California have led to lower payment rates and could incentivize insurers to end contracts with better-paid providers.
The outcome of the controversy remains uncertain, with some suggesting it may be resolved in courts while others believe there is still room for changes to the regulations, especially given the significant opposition from lawmakers.
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