AMA/AHA Lawsuit Over Federal No Surprises Act Provision Shows Patient Billings Remain a Sore Spot

The tug of war between healthcare providers and insurers over medical billing practices is casting a spotlight on how medical costs and payment responsibility are impacting patient experience.

On Dec. 9, The American Hospital Association (AHA), the American Medical Association (AMA) and others sued the federal government to dispute recent provisions added to the No Surprises Act passed by Congress in late 2020 that prevents consumers being hit with unexpected out-of-network charges.

The dustup illustrates how patients are being seen more as paying consumers in a post-pandemic healthcare landscape that’s being forced to refashion outdated billing and payment practices.

In a statement, AHA President and CEO Rick Pollack said, “No patient should fear receiving a surprise medical bill. That is why hospitals and health systems supported the No Surprises Act to protect patients and keep them out of the middle of disputes between providers and insurers. Congress carefully crafted the law with a balanced, patient-friendly approach and it should be implemented as intended.”

The associations and providers are suing the U.S. Department of Health and Human Services (HHS) over “a narrow but critical provision” of a rule issued on Sept. 30 by HHS claiming that “the provision being challenged ignores requirements specified in the No Surprises Act and would result in reduced access to care for patients. The rule and this flawed provision are set to take effect Jan. 1, 2022.”

A Dec. 10 blog post by healthcare advocacy nonprofit the Kaiser Family Foundation (KFF) explained, “The No Surprises Act (NSA) establishes new federal protections against surprise medical bills that take effect in 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose.”

See also: Patients to Providers: Healthcare Billing Should Be Seamless, Frictionless and Transparent

It’s ultimately a battle between insurers and healthcare providers over who’s responsible for common out-of-network care delivery from ambulance rides to other services that consumers had no say in.

Clearly, industry associations and healthcare providers are concerned not just with the financial aspects but with the impact on patient experience caused by unexpected medical billing.

As The Access Channel: How Healthcare Financing Keeps Patients Engaged, a PYMNTS report with research sponsored by CareCredit, noted, “The average patient spent approximately $1,150 on out-of-pocket healthcare expenses — excluding the costs of health insurance premiums — during the past 12 months. Adding to consumers’ financial pressure is a predicted steady rise in out-of-pocket expenses. Healthcare costs not covered by health insurance rose 10 percent this year and are expected to continue increasing through 2026.”

Get the study: The Access Channel: How Healthcare Financing Keeps Patients Engaged