MANHATTAN (CN) — A New York surgeon and his medical practice asked the Second Circuit Wednesday to strike down a federal law that bans “surprise bills” from medical providers for any costs that a patient’s insurance doesn’t cover.
The No Surprises Act passed by Congress in 2020, caps patients’ individual responsibility for certain out-of-network care at an amount comparable to what the patient would have owed had they received the same care in-network.
The law also prohibits “balance billing,” the practice of providers billing patients for the difference between the provider’s charge and the amount covered by insurance.
Dr. Daniel Haller, a surgeon with Long Island Surgical, claims the law is unconstitutional because providers can't challenge the prohibition to balance billing. If a provider complains to the insurer, the insurer may then elect to participate in a mandatory arbitration procedure, called the Independent Dispute Resolution.
“There’s no language that says this is a voluntary alternative for the parties to come together,” Nicholas Joseph Wilder, an attorney for Haller, said during oral arguments on Wednesday. “The process is initiated when one party chooses to do so. From that point on, the other party has to respond.”
Haller also claims the law favors the insurance companies and unfairly places the financial burden on medical providers.
“The clear intent to weigh the scales in favor of the insurance companies and to engage in cost-shifting to medical providers is a senseless, destructive strategy, and the means are unconstitutional,” Haller said in his brief.
A federal judge dismissed Haller's claim, finding he failed to demonstrate that the law prevents medical providers from billing patients directly.
At the Second Circuit Wednesday, the plaintiffs claimed the law prevents them from suing insurers over billing disputes.
Sarah Jane Clark, an attorney for the United States, argued that Haller's case should be dismissed because, by shifting the argument from patients to consumers, he forfeited his original claim.
“The claim that plaintiffs brought was premised on claims against patients,” Clark said Wednesday. “It’s not up to the district court to say, you know what, if you had brought a different claim, one based on insurers — that simply was not the issue.”
Wilder argued that his client did not forfeit his original claim; he simply changed his argument.
“The argument is that the providers are being denied the ability to sue insurers even though there is an extensive body of common law which gives them the same exact relief we have here which is unjust enrichment.”
Clark shot back.
“They have fundamentally changed the nature of their challenge here,” Clark said. “We’re not in the world of, ‘We’ve thought of a new argument in support of the same claim.’”
The case appeared before U.S. Circuit Judge Michael H. Park, a Trump appointee, and U.S. Circuit Judges Eunice Lee and Sarah A.L. Merriam, both Joe Biden appointees.
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