‘Giveaway for private insurers’: ACR requests summary judgment without trial in surprise billing suit

The American College of Radiology and other doc groups requested a summary judgment from an Illinois court Wednesday, hoping to avoid a trial in their lawsuit over surprise billing legislation.

ACR, the American College of Emergency Physicians and the American Society of Anesthesiologists are hoping to reach a rapid resolution, with the law already in effect since Jan. 1. Those involved said they support efforts to protect patients from surprise bills but are concerned the current approach is tilted heavily in the favor of payers.

“Without regard for patient impact, insurers are using the federal rule to narrow provider networks, which will deny patients’ access to their chosen providers and inflate already record insurer profits,” Howard Fleishon, MD, chair of the ACR board of chancellors, said in a statement. “Rural and underserved communities may be hit hardest by this overreach that can result in longer wait times for care, delayed diagnosis and higher out of pocket costs to treat more advanced conditions. The court can stop this now by granting our motion for summary judgement.”

Physicians first filed their suit against the federal government in late December. They contend that, under Congress’ original intent, mediators were supposed to consider a host of factors when settling disputes between payers and out of network providers. However, the Biden administration’s implementation of the rule, instead, emphasizes one variable—the health insurer’s median in-network rate. ACR et al. said this gives insurers the power to “strongarm” physicians out of network and drive down rates.

Several other provider groups previously sued the feds over the rule, including the American Medical Association and the Texas Medical Association. Physicians argued that insurer profits have skyrocketed in recent years while costs dropped, with no corresponding reduction in premiums.

“There is no indication — nor proof — that insurer profit increases gained via No Surprises Act-related network restrictions would result in lower costs to patients,” ACR, the American College of Emergency Physicians and the American Society of Anesthesiologists said in their statement Wednesday. “Neither the lawsuit nor the filing for summary judgement impact patient protections in the new law nor increase patient healthcare costs,” they added.