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Surprise Medical Bills

  • No Surprises Act

    The federal No Surprises Act became effective Jan. 1, 2022. It established a federal law prohibiting balance billing for out-of-network, self-pay, and uninsured patients from certain surprise medical bills. The law also created patient price transparency rules by requiring certain physicians to provide their patients with good faith estimates.

  • What Physicians Need to Know

  • Surprise Billing: State vs. Federal

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    Texas law and federal legislation both have systems to address payment disputes between physicians and health plans using independent dispute resolution (IDR). But they also have some key differences.

    Some of the Ways They Compare  

  • Surprise Billing InfographicAlt Tag

  • AMA Resources Dissect Federal Surprise Billing Law

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    Much of the federal government’s solution to resolve certain out-of-network billing disputes took effect at the start of 2022. To help physician practices understand and navigate the new law, the American Medical Association has created two No Surprises Act toolkits. TMA also offers an updated list of resources on the new law.

    Read about Preparing for Implementation of the No Surprises Act.

    Read about Disputing Out-of-Network Payments Using the No Surprises Act Independent Dispute Resolution Process.

    View the AMA webinar, Out-of-Network Payment Process Under the No Surprises Act, that was held on Thursday, Apr. 21. Access a recording of the webinar and the presenters' slides.

  • Federal Surprise Billing Law in Effect: Get Educated

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    TMA and American Medical Association leaders are urging physicians to get educated now about the new federal law on surprise medical billing. Many related practice changes were the subject of an AMA educational webinar held Jan. 20, which will also be available as a recording.

    See a Recap  

  • Federal Independent Dispute Resolution Opened: What That Means

    On Friday, April 15, 2022, the Centers for Medicare & Medicaid Services (CMS) opened the federal Independent Dispute Resolution (IDR) portal process for the No Surprises Act (NSA). It is intended to resolve payment disputes for certain out-of-network charges.

  • The Updated Skinny on Texas’ Surprise Billing Law

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    The Texas Medical Association has updated its white paper on Texas’ law for settling out-of-network billing disputes involving state-regulated health plans.

    See the Newly Amended Rules  
  • No Surprises Act: Litigation

  • TMA Wins Fourth Lawsuit Challenging Payment Calculations in Surprise Billing Arbitration

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    Marking a fourth victory for the Texas Medical Association in as many lawsuits, a court struck down a large portion of the regulations setting forth a methodology insurers use to calculate the qualifying payment amount, or QPA, used in surprise-billing disputes – part of a series of federal rules TMA has long argued skew the arbitration process in insurers’ favor.

    Learn More  

  • TMA Pleased Court Strikes Down Steep Fee Hike and Batching Rules in NSA Cases

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    Statement by Rick W. Snyder II, MD, Texas Medical Association (TMA) president, in response to the ruling by the U.S. District Court for the Eastern District of Texas on TMA's fourth No Surprises Act lawsuit. TMA challenged a 600% hike in administrative fees and batching rules used in arbitration cases governed by the federal law.

    Learn More  

  • Federal Memo Signals Compliance With TMA Court Win – For Now

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    Within days of TMA's Feb. 23 court victory over federal regulators, the U.S. Department of Health and Human Services says it’s taking steps to comply with the court’s decision on rules for the No Surprises Act. However, the case may not be over yet.

    Read the Government's Memo  

  • TMA Win on Surprise-Billing Rule Also a Win for Access to Care

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    When the Texas Medical Association scored a win over federal regulators in a Feb. 23 U.S. district court decision, it wasn’t just a victory for physicians. It was a victory for patients, too. The court sided with TMA in its attempt to stop a piece of rulemaking tied to the federal No Surprises Act.

    Why Patients Also Won  

  • TMA Sues Feds Over Arbitration Rule for Surprise Billing Law

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    TMA has sued federal authorities over rulemaking for the federal surprise billing law, saying it failed to follow clear direction from Congress about how to implement the dispute resolution process meant to determine fair payments for out-of-network care.

    Read Why TMA Is Going to Court  

  • Surprise Billing Rules Garner More Legal Action

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    Pressure is mounting on federal authorities with multiple legal actions, including TMA's, aiming to stop what physicians and hospitals say is an unfair arbitration process outlined in rules implementing the No Surprises Act, legislation passed in 2020 to address surprise medical bills.

    The Latest On the Lawsuits  
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  • Out-of-Network, Balance Billing Laws in Texas