Dive Brief:
- An air ambulance operator has filed suit against the federal government over the implementation of the No Surprises Act, the law that protects consumers from unexpected bills when they are unknowingly treated by providers outside of their insurance networks.
- Despite an earlier ruling that favors providers, LifeNet, the plaintiff, claims the federal government continues to treat air ambulance providers differently, as if part of the law relating to guidance for arbitration was not struck down, according to the lawsuit filed last week in the Eastern District of Texas.
- LifeNet is requesting the case be assigned to Judge Jeremy Kernodle for the Eastern District of Texas, who ruled in favor of providers in the earlier case.
Dive Insight:
The No Surprises Act continues to face legal challenges from providers who have objected to the arbitration guidance.
The central issue in the air ambulance lawsuit, and others such as a suit brought by the Texas Medical Association, is the guidance the federal government has provided to third-party arbiters. The American Hospital Association and American Medical Association have brought a similar challenge that targets the same piece of the law.
To shield patients from unexpected medical bills, part of the law allows payers and providers to enter into arbitration when they cannot agree on reimbursement for care. It's viewed as a last resort for the two sides.
At the center of the controversy is how the Biden administration chose to implement the law, and the arbitration process specifically, which providers say tips the scale in favor of payers and conflicts with the way Congress wrote the law.
The guidance in question instructed arbiters to start with the presumption that the qualifying payment amount, or QPA, is the correct payment amount. The QPA is the median in-network rate. Providers say starting with this presumption effectively sets a ceiling on prices.
A federal judge sided with providers and struck down this piece of the rule. The Department of Justice is appealing that ruling.
But LifeNet argues air ambulances providers are still being held to the presumptive QPA, and call it "arbitrary" and "irrational," according to the lawsuit.
LifeNet is based in Texas and transports patients in Louisiana and Arkansas and operates three air bases, according to the lawsuit.