I wish I could claim that I was that clever. So I get the Yogi Berra reference, Chris. There's no compromising or averaging or that sort of thing.
It focuses on that framework, which, as you alluded to, is the arbitration mechanism that decides how much a payer, like an insurer or an employer plan, will pay an out-of-network provider.Īnd the IDR in the No Surprises Act is what's known as baseball style arbitration, which means that both sides pick a number. As you mentioned, the previous like the previous case brought by the Texas Medical Association, this current lawsuit focuses on the NSA's independent dispute resolution or IDR. Well, it's as they as I think it was Yogi Berra used to say it's déjà vu all over again, Kathleen. It seems, however, that surgeons and anesthesiologists among other providers are not happy with the process set up by the government to resolve disputes over what insurers should pay these providers when there's no network fees SCO to go by.Ĭhris, what's happening with this litigation? Let's recall that the NSA prohibits out-of-network doctors and other providers from, in most circumstances, billing patients at rates higher than in network amounts. Last week, the Texas Medical Association sued the Biden administration again over the NSA's independent dispute resolution process.Īnd this came after a string of lawsuits about the same topic. So Chris, let's start with the litigation around the No Surprises Act or the NSA. A third issue involves a challenge to ACA's preventive services coverage mandate. Specifically, whether and when consumers can count the value of drug manufacturer coupons towards their deductibles and out-of-pocket maximums. Another conflict also concerns provider payment. The law enacted last year to ban surprise medical bills. In one set of cases, providers are challenging federal rules governing their payments under the No Surprises Act. We'll look at three issues which have been prominent in the past weeks and months. Today, we've decided to take a look at recent health policy litigation. Hello and welcome to another episode of Health Affairs This Week, the podcast where Health Affairs editors go beyond the headlines to explore some of the most notable health policy news of the week.
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