Vitori Health

August 2, 2022

2 min

The landmark No Surprises Act became effective January 1, 2022 to protect consumers from surprise medical bills from out-of-network providers and facilities. Greedy industry stakeholders are fighting to remove these long overdue protections. Is anyone surprised?

While major players publicly agree that patients deserve protection, they are quick to dispute those statutes that cut into their share of the lucrative healthcare pie.

The American Medical Association (AMA) and American Hospitals Association (AHA) jointly sued the federal government before the act even became effective. Their complaint is with aspects of the independent review process that they believe unfairly benefit commercial health insurance companies and “all but ensure that hospitals, physicians, and other providers will routinely be undercompensated by commercial insurers.”

Earlier this year, a federal judge in Texas ruled in favor of the Texas Medical Association, also taking aim at provisions of the arbitration process for determining payment for services by out-of-network providers. This ruling struck down the challenged provisions for all providers across the country who may be subject to them.

Most outrageous is the acute-care surgeon in New York who “argues the entire law should be thrown out because it violates his constitutional rights to bill patients directly for any “balance of the fair value” of his services, according to his complaint.” A related article says “the lawsuit shows just how much some providers rely on out-of-network charges, and how far they are willing to go to dismantle a measure that shields patients from getting blindsided.”

According to Frederick Isasi, executive director of the consumer healthcare group, Families USA, the surgeon’s lawsuit highlights that “physicians who are working in specialties that are hard to fill are able to keep themselves out of network. It is part of their business strategy to say, ‘I want to be able to set whatever price I want with a patient.’ This isn’t the way health care is supposed to work. It’s outrageous. It’s unethical.”

We couldn’t agree more.

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