Fifth Circuit Upholds Surprise Medical Bill Dispute Pay Formula

The Biden administration’s method for calculating health-provider rates in resolving surprise medical billing disputes was upheld by the Fifth Circuit Wednesday.

The panel reversed a lower court’s ruling that the federal government’s methodology to determine a key benchmark under the No Surprises Act of 2020 exceeded the statute’s bounds.

The surprise billing law protects patients from out-of-network medical bills for certain emergency care, as well as care received from out-of-network clinicians at in-network facilities. Medical providers and health insurers must now settle most out-of-network disputes through the law’s arbitration process.

Courts have instructed the Centers for Medicare and Medicaid Services, ...