The arbitration process between out-of-network providers and payers under the No Surprises Act received another setback in a Texas court this week.

The case pitted the Texas Medical Association and medical providers nationwide against the U.S. Department of Health and Human Services. U.S. District Judge Jeremy Kernodle ruled that the revised arbitration process “continues to place a thumb on the scale” in favor of insurers and that “the challenged portions of the final rule are unlawful and must be set aside.”