Several lawsuits challenge No Surprises Act that impacts medical bills

Posted at 1:39 PM, Apr 08, 2022

Lawsuits challenging the No Surprises Act are popping up all over the country.

The new law that took effect this year protects us from getting surprise medical bills when we get certain out-of-network medical treatments.

“I would emphasize it's not every type of provider that sends these surprise bills. It tends to be focused on one’s that might be owned by a private equity company or have a real profit margin. Many have been using patients and using the surprise bills to make a lot of money. So it threatens how much they're going to make and so they're suing over it,” said Katie Keith and Georgetown University’s Center on Health Insurance Reforms.

Experts and advocates for health insurance reform are drawing attention to these lawsuits.

They say their outcomes could bring changes to the No Surprises Act or eventually lead to higher insurance premiums.

In Texas, one court has already sided with a challenge involving arbitration to settle bill disputes.

“But if you take off that guardrail there's sort of this risk that providers use. Arbitration is an opportunity to get higher rates when it's not warranted. For them to be doing so, all those higher rates of insurance companies have to pay providers more -- that all trickles down to all of us,” said Keith.

Patricia Kelmar at U.S. PIRG says there is action being taken to fight this type of surprise billing.

“We've filed an amicus brief to support the government to make sure the law stays strong,” said Kelmar.

If the New York lawsuit is successful, it threatens the entire act.

For now, advocates want you to know that you should not be surprised with out-of-network bills.

For the most common practices, like ER care, air ambulances and anesthesiologists.

However, certain services are not covered in the act.

“We're starting to see now more in provider offices, the opportunity to have your blood drawn there, or maybe even get some testing done or some imaging done. Just because it's in your in-network providers office, (it) doesn't necessarily mean that's an in-network service, So we also ask you to always make sure that you double-check before you get your blood drawn or an EKG done, or something like that. Those services are not out of network,” said Kelmar. Even with the act in place, patients are advised to research in advance so they can be informed about their in-network providers.

You can find more information about the new protections here.