Answering a certified question from the U.S. Court of Appeals for the Fifth Circuit, the Texas Supreme Court ruled non-network emergency physicians cannot bring private lawsuits against insurers for failure to reimburse at ‘usual and customary’ rates.

The claims brought by the plaintiff doctors applied to billings prior to 2020 because the Texas Insurance Code was changed to a mandatory arbitration process to resolve payment disputes, effective Jan. 1, 2020.