A federal appeals court on Tuesday struck down a formula used by healthcare providers, insurers, and the government to shield patients from surprise medical bills. The 5th U.S. Circuit Court of Appeals in New Orleans ruled that the formula, known as the qualifying payment amount (QPA), was improper because it included “ghost rates” and excluded bonus and incentive payments.
The No Surprises Act
The case concerned the No Surprises Act, a 2020 law requiring healthcare providers and insurers to negotiate reimbursement rates themselves rather than stick patients with huge bills for out-of-network treatments, especially in emergencies. Providers, including the Texas Medical Association and air ambulance operators, challenged the method for calculating the QPA, saying it favored insurers at their expense.
The court’s decision partially restored a district court ruling favoring the healthcare providers, which a three-judge 5th Circuit panel later reversed. The ruling may lead to changes in how surprise medical bills are handled, but the court assured that it would not lead to “all-out chaos” because the government could let insurers retain the existing formula while a replacement is crafted.
Original reporting: Appleton, WI News Feed (HLL/CB) — read the source article.
