A proposed $2.8 billion settlement has been reached between the Blue Cross Blue Shield Association (“BCBSA”) and healthcare providers. It resolves claims that BCBSA violated antitrust laws by dividing service areas and fixing prices. The settlement … [Read more...] about BCBS $2.8B Anti-Trust Settlement — How to File
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Legal Motion Filed to Rehear Fifth Circuit’s Decision on Inclusion of Ghost Rates in NSA QPA Calculation
The No Surprises Act (NSA), enacted in December 2020, was designed to protect patients from unexpected medical bills for emergency services and certain non-emergency services provided by out-of-network providers. A central component of the NSA is … [Read more...] about Legal Motion Filed to Rehear Fifth Circuit’s Decision on Inclusion of Ghost Rates in NSA QPA Calculation
The No Surprises Act: A Practical Perspective
Nearly three years after the No Surprises Act (“NSA”) became effective, there have been many surprises along the way. From the four lawsuits by the Texas Medical Association challenging the implementation of the Act, revisions to rules put forth by … [Read more...] about The No Surprises Act: A Practical Perspective
A History of Legal Battles: The Texas Medical Association’s Multi-Lawsuit Campaign under the No Surprises Act
Last week, the U.S. Fifth Circuit Court of Appeals held that regulations implemented by the Departments of Health and Human Services, Labor, and Treasury were permitted to include "ghost rates"—contracted rates for services that were never actually … [Read more...] about A History of Legal Battles: The Texas Medical Association’s Multi-Lawsuit Campaign under the No Surprises Act
Fifth Circuit Upholds TMA II Decision
Late on Friday, August 2, the Fifth Circuit Court of Appeals upheld a crucial ruling in the Texas Medical Associations (TMA) II lawsuit, marking another substantial victory for out-of-network providers and the TMA. This landmark decision affirms … [Read more...] about Fifth Circuit Upholds TMA II Decision
US SENATORS SUMMON MULTIPLAN’S CEO TO DISCUSS ALLEGED NEFARIOUS BUSINESS PRACTICES
On May 22, U.S. Senators Ron Wyden (D-OR), Chair of the Finance Committee and Bernie Sanders (I-VT) Chair of the Health, Education, Labor and Pensions (HELP) Committee issued a letter to Travis Dalton, CEO of MultiPlan. Mr. Dalton is being called … [Read more...] about US SENATORS SUMMON MULTIPLAN’S CEO TO DISCUSS ALLEGED NEFARIOUS BUSINESS PRACTICES
NY Times Investigation Exposes Multiplan & Insurer’s Hidden Financial Incentive Practices
Last Sunday the New York Times published two articles written by journalist Chris Hamby, regarding Multiplan and the major health insurance companies. His investigation exposed the "Percentage of Savings Model", used by Multiplan and insurers that … [Read more...] about NY Times Investigation Exposes Multiplan & Insurer’s Hidden Financial Incentive Practices
Federal Texas Court Orders Government Agencies to Vacate NSA Fee Increase and Batching Rule
As previously reported, the Texas Medical Association (TMA) filed a series of lawsuits over the rules implemented by the Departments under the No Surprises Act. On August 3, 2023, Judge Kernodle, US District Court of Eastern Texas, ruled in favor of … [Read more...] about Federal Texas Court Orders Government Agencies to Vacate NSA Fee Increase and Batching Rule
Federal Government Appeals No Surprises Act (NSA) TMA II Decision Concerning the QPA
In a recent development surrounding the implementation of the No Surprises Act (NSA), the United States Department of Justice (DOJ) has filed an appellate brief to appeal the Texas Medical Association (TMA) II decision. This decision vacated certain … [Read more...] about Federal Government Appeals No Surprises Act (NSA) TMA II Decision Concerning the QPA
NJ DOBI Issued Bulletin No. 23-05, June 28, 2023, Non-Discriminatory Coverage for Transgender Individuals
In an effort to promote equal access to healthcare and coverage, the New Jersey Department of Banking and Insurance has published Bulletin No. 23-05 following Governor Murphy’s issuance of Executive Order 326, “Protecting Gender-Affirming Health Care … [Read more...] about NJ DOBI Issued Bulletin No. 23-05, June 28, 2023, Non-Discriminatory Coverage for Transgender Individuals
Court Decision in TMA Lawsuit Good News for Providers
This week, a Texas US Federal District Court granted a summary judgement in favor of the Texas Medical Association (TMA) setting aside and vacating the latest qualifying payment amount (QPA) Rule as violating the No Surprises Act (NSA). The Court … [Read more...] about Court Decision in TMA Lawsuit Good News for Providers
Federal Agencies Levy Substantial Increase in Administrative Filing Fees for NSA IDR in 2023
Late Friday afternoon on December 23, 2022 and well after most had begun celebrating their holiday, CMS quietly announced that it was increasing the non-refundable administrative fee for all IDR filings initiated under the No Surprises Act from $50 … [Read more...] about Federal Agencies Levy Substantial Increase in Administrative Filing Fees for NSA IDR in 2023
