Nutex Health applauds Fifth Circuit ruling rejecting “ghost rates” in No Surprises Act QPA calculations
NUTX•Fifth Circuit ruling on No Surprises Act QPA calculations
Nutex Health welcomed a Fifth Circuit en banc ruling that struck down parts of federal rules for No Surprises Act QPA calculations.
CEO Tom Vo said insurer use of unnegotiated “ghost rates” depressed QPAs since 2022, forcing more costly, time-consuming IDR disputes.
The court found no basis to allow $1 placeholder rates while excluding $0 rates. It also rejected excluding bonus and incentive payments from QPAs.
Impact on patient protections and insurer billing practices
Patient balance-billing protections under the law remain unchanged; the dispute centers on insurer-provider payment levels for out-of-network care.
Insurers may need to recalculate QPAs once new rules are issued. Current enforcement relief allows prior methods before Oct. 1, 2026.
