AMA-AHA Surprise Billing Claim Was Dismissed

The American Hospital Association and the American Medical Association have completed one federal arbitration lawsuit over surprise billing but plan to try again, the organizations announced Tuesday.

“We have serious concerns that the August 2022 Final Rule is at odds with the intent of Congress, as is the September 2021 Interim Final Rule. Hospitals and physicians are committed to making sure our voices are heard in the courts over these ongoing issues very soon,” the AHA and AMA said in a joint statement.

Fellow AHA and AMA plaintiffs are UMass Memorial Health Care of Worcester, Massachusetts, Renown Health of Reno, Nevada, Dr. Stuart Squires and Dr. Victor Kubit – also rejected their claims to the government.

In December, two medical associations filed a lawsuit against the federal government, arguing that a sudden billing arbitration process would hurt providers by underpaying for out-of-network services. The interim regulation required the arbitrators to choose the offer closest to the insurer’s median in-network contract rate.

In February, the US District Court for the Eastern District of Texas ruled in favor of the providers in a separate arbitration lawsuit. This decision is reflected in the regulators’ final rule on process, which requires arbitrators to consider both an insurer’s network median contract rate and additional information when deciding whether to pay a surprise bill.

The AMA and AHA’s ongoing lawsuit is moot, after regulators released the final rule on the surprise billing arbitration process in August, an AHA spokesperson said.

However, providers are unhappy with the final rule and are planning additional lawsuits over the arbitration process. The AHA and AMA did not respond when asked about their specific concerns.

The AMA and AHA lawsuit was merged with the Aviation Medical Services Association’s complaint against the same process in February. The Air Medical Services Association is not listed on the list of plaintiffs who dismissed their claims on Tuesday and did not respond to a request for comment.

The parties are due to hold a status hearing before Judge Richard Leon of the U.S. District Court for the District of Columbia on Wednesday.

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