Recently, an air ambulance service provider sued the federal government over the new No Surprises Act. The contention, however, is not whether the patients are to be involved in the payment recovery process. According to the Act, the patients are only liable to pay costs such as co-pay which are previously agreed upon between the insurance company and the insured.
Balance billing, which was known to run people into bankruptcy, ceases to be a practice. Any balance amount now becomes an issue that needs to be sorted out between the air ambulance companies and the insurance providers. In case of disagreements between the two parties, they are supposed to go through an arbitration process laid down by the Act. The patient has nothing to do with it.
The Contention of the Air Ambulance Company
The part of the Act that is in question is QPA or qualifying payment amount. This is a pre-set amount for any air ambulance transport. It is a median in-network payment rate. The rate is a part of the No Surprises Act. However, the air ambulance company claims that it tilts the scales in the favor of the health insurance providers if a case goes into the arbitration process.
In fact, a federal judge has struck down this part of the Act; however, the DoJ is appealing against it currently. In the meantime, QPA continues to be in effect. The air ambulance company is contending this approach by suing the federal government.
Other Organizations have Filed Law Suits
American Medical Association and The American Hospital Association too had filed similar lawsuits earlier. The argument was that the settlement process in case of disputes favors the health insurance providers. Specifically, when out-of-network services come into the picture. In summary, it is about the balance of power between air ambulance operators and health insurance providers.