By Leila Merrill
WASHINGTON, D.C. — The Association of Air Medical Services has filed a lawsuit in federal court over the interim final rules of the No Surprises Act — which Congress passed in December 2020 to protect patients from surprise bills resulting from coverage gaps for emergency services and some out-of-network doctors.
With the act going into effect on Jan. 1, the lawsuit challenges key parts of the new federal independent dispute resolution process, which is going to be used to resolve disputes between payers and out-of-network providers.
The AAMS suit, filed in November, follows a lawsuit from the Texas Medical Association and a Texas emergency room physician that focused on the same issue.
“Air Medical Services transport the sickest, most severely injured patients in our healthcare system — we fully support protecting those patients from these payment disputes and worked with Members of Congress and our larger healthcare community partners to ensure that happens,” said Cameron Curtis, AAMS president and CEO. “However, the fair and transparent process that we all supported is not the process being implemented. Instead, we are faced with a scenario in which a patient is in an emergency, is transported by a helicopter at the request of a trained first responder or qualified physician, and that patient’s insurer gets to unilaterally determine the amount they pay. This will have disastrous consequences for access to emergency air ambulance services.”
The AAMS said in a news release that it supports the goals of the act, but the way the rules are set up would lead to insurers lowering payments and could affect the sustainability of air medical services and the U.S. healthcare system in general.
By contrast, a Health Affairs Journal blog post says that, “if the lawsuits succeed, the federal IDR system could become more costly and undermine the savings that Congress expected when the law was enacted. Without some of 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 based on the circumstances. Patients would still be protected from surprise medical bills — but consumers, employers and the government could face higher premiums.”