Texas providers have notched their first win in the legal battle over the No Surprises Act (NSA), the federal law that bans surprise billing — though the Biden administration can appeal the decision. In a lawsuit brought by the Texas Medical Association (TMA), Judge Jeremy Kernodle of the federal Eastern District of Texas on Wednesday struck down regulations issued by the Biden administration that providers allege favor insurers at their expense in balance-billing scenarios.
The NSA requires payers and providers to work out the balance billing disputes between themselves. If that fails, an HHS-approved independent arbitrator will decide between two payment amounts: one submitted by the provider and one by the insurer. Arbitrators then pick between one of the two proffered amounts using criteria designed by the Biden administration.