"The only issue is whether the independent arbitration process between health insurance plans and providers will be implemented by federal agencies in a fair and balanced way," AMA and AHA wrote in a statement. (Photo: Shutterstock)
Then-President Donald Trump signed the No Surprises Act into law in December 2020, and it went into effect on January 1 this year. The law protects patients from the most pervasive types of surprise out-of-network bills and creates a new federal independent dispute resolution (IDR) process to resolve payment disputes between payers and out-of-network providers. As one might expect, not everyone is happy with the new rules.
Several providers have taken issue with the implementation of the federal IDR process have sued the Biden administration over two interim final rules. The first lawsuit was filed last October by the Texas Medical Association and a Texas-based emergency room physician in the eastern district of Texas. The second was filed in November by the Association of Air Medical Services in the District of Columbia.
Recommended For You
Since then, four more lawsuits have been filed. Three of them — filed in the District of Columbia, Georgia and Illinois — raise complaints similar to the Texas lawsuits. The fourth lawsuit, filed in New York, echoes those same challenges to the IDR rule but also argues that major provisions of the act are unconstitutional.
"While litigation over major health-care rules is common, providers have been particularly aggressive about challenging the act in court," HealthAffairs reported. "By filing six lawsuits in five different jurisdictions, providers are trying to maximize their chances that at least one lawsuit succeeds. They also may be trying to pressure the Biden administration into altering the current interpretation in a way that they perceive as more friendly to their financial interests. We may learn soon enough whether this latter strategy has been successful: federal officials are expected to issue a final IDR rule by May 2022."
The American Medical Association and American Hospital Association issued a joint statement explaining their role in the litigation while still supporting the No Surprises Act overall.
"These consumer protections are already in effect and are not being challenged in any way," it said. "The only issue is whether the independent arbitration process between health insurance plans and providers will be implemented by federal agencies in the fair and balanced way Congress intended."
If the lawsuits succeed, parts of the IDR rule could be set aside.
"Without the guardrails put in place by the Biden administration, providers could be more likely to use the federal IDR process to obtain higher out-of-network payments when doing so is not warranted," the HealthAffairs report concluded. "This could make the IDR process more likely to become inflationary, leading to higher health care costs and premiums for consumers, employers and taxpayers. If the constitutional challenge succeeds in the New York lawsuit, the effects would be even more severe."
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
