On Friday, August 2, the Fifth Circuit Court of Appeals upheld a prior decision in the Texas Medical Associations (TMA) II lawsuit, marking a substantial victory for out-of-network providers and the TMA. This landmark decision affirms that the median in-network rate, or Qualifying Payment Amount (QPA), cannot be the sole factor considered by arbitrators in resolving payment disputes between providers and commercial health insurance companies.
The court reiterated that Congress intended for arbitrators to consider all statutory factors equally, without giving undue weight to any single one, and found efforts by the Federal Agencies to restrict arbitrators’ evaluation of all factors were in direct violation of the Acts explicit terms. This ruling supports fair arbitration practices under the No Surprises Act (NSA), ensuring that all relevant factors are given due consideration.
This ruling is a major win for out-of-network providers. We remain committed to providing key updates concerning the No Surprises Act and are happy to address any concerns you may have. Call us today!