A federal judge in Texas tossed portions of a rule that established an arbitration process Congress called for to shield patients from surprise medical bills. The results of this ruling could have far-ranging consequences for medical insurance billing claims, hospital bills, and more.
What is Arbitration?
Arbitration is a way of having a neutral person (“arbitrator”) decide who wins and loses outside of a courtroom.
What Are Surprise Medical Bills?
Surprise medical bills are those bills that a patient receives from doctors for medical care that is not covered by health insurance even though the patient went to a facility that should be covered by health insurance.
What Happened to Cause the Judge to Toss Portions of the No Surprises Act?
Essentially, the trial judge found that the federal government agency in charge of coming up with rules to implement the surprise medical bill law (No Surprises Act) failed to follow proper regulation-making procedure when it required arbitrators to select the amount of a medical procedure bill closest to the middle rate for the procedure were the procedure to be covered by health insurance. Bloomberg News’ Law News site has a story on this situation.
This requirement was to take place in settling payment disputes between insurers and certain healthcare providers not covered by insurance. In other words, if the government was going to make an interpretation of the law, it was required to follow a certain procedure.
Because the trial judge did not think that happened, the particular regulation has no effect.
What is the Opinion of Health Insurers and Hospitals on This Ruling?
Groups at odds with each other over the ruling consist of health insurers and hospitals.
Health insurers argue that the regulation would keep costs down and that arbitration would help keep medical claim payments lower helping keep health insurance premiums down.
Hospitals argue that the regulation could create unfairness, which they believe would lead to lower allowed prices.
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