The independent dispute resolution (IDR) process under the No Surprises Act has resulted in an estimated $5 billion in additional costs to the U.S. healthcare system within its first three years of implementation, according to research published in Health Affairs. This inflation of spending is primarily driven by providers winning a large majority of disputes and securing higher payments.
Arbiters processed over 1.3 million disputes in the first half of 2025, a 50% increase from the prior six months, while providers and health insurers submitted almost 1.2 million new cases, nearly 40% more than in the last half of 2024. Despite this increased processing speed, about 20% of submitted disputes during the first six months of 2025 were ineligible, contributing to delays. A significant portion of disputes, nearly 70%, were initiated by a handful of primarily private equity-backed provider groups, raising concerns about exploitation of the IDR process for profit. Specifically, HaloMD, Team Health, and SCP Health accounted for approximately 44% of all initiated disputes.
Providers are highly successful in these disputes, winning 88% of cases in the first half of 2025, an increase from 85% in the last six months of 2024. When providers win, they are often paid three to four times above comparable in-network rates. A study by Elevance Health found that awards for planned procedures were often 50 times the median in-network contracted rate, with the average IDR award for studied procedures being nearly $40,000, significantly higher than benchmarks ranging from approximately $645 to $1,600. In 2024, the average amount awarded when providers won was nearly 450% of the qualifying payment amount (QPA), a benchmark for median in-network payment, with one private equity group averaging 770% of the QPA. In contrast, when health plans prevailed, the average payment rate was 110% of the QPA.
Overall, more than 3.3 million disputes were filed in the three years following the IDR portal's launch in April 2022. The Congressional Budget Office (CBO) initially estimated the Act would lower provider payments and commercial insurance premiums by roughly 1%, while reducing federal deficits by $17 billion through 2030. However, new data suggests a different trajectory, with the CBO noting that if providers can consistently secure large payments through IDR, it incentivizes them to remain out of network or demand higher in-network rates, potentially leading to increased prices, higher commercial insurance premiums, and larger federal deficits. The industry awaits a final rule from regulators to clarify IDR operations, aiming to improve eligibility determinations and speed up payment resolutions.
