While the patient protections put in place with the No Surprises Act are working, new research from the Elevance Health Public Policy Institute suggests that the law’s payment dispute process is producing unexpected results for some planned medical procedures.
The No Surprises Act, created to protect patients from unexpected medical bills, took effect in 2022 and allows for either insurers or providers to bring disputes over payment for services covered by the law to an independent arbitrator.
But federal Independent Dispute Resolution volume has grown far beyond initial projections, raising concerns that a process intended as a limited payment-dispute backstop is increasingly contributing to higher out-of-network costs.
See also: Employers demand changes to No Surprises Act arbitration
The institute’s study examined more than 7,300 payment disputes involving procedures and services that are typically scheduled in advance, such as spine surgery, plastic surgery, colonoscopy and other scheduled services. These procedures qualified for the dispute resolution process because they were performed at in-network facilities by out-of-network providers. Researchers found that providers won nearly 90% of disputed claim lines and that payments awarded through the federal IDR process were often tens to hundreds of times higher than typical in-network commercial rates and Medicare payment rates.
“The No Surprises Act was designed to protect patients from unexpected medical bills, not to increase healthcare costs,” Catherine Gaffigan, president of health solutions at Elevance Health, said in a statement. “Our Public Policy Institute’s research raises serious concerns that the dispute resolution process is being used for certain scheduled services in ways that diverge from the law’s original intent.
“When the system is exploited, the result is higher costs for employers and families who ultimately bear the burden through higher premiums and health care expenses. Preserving patient protections requires ensuring that the dispute resolution process is used appropriately and functions as Congress intended.”
Other findings from the study:
- Providers won 89.5% of disputed claim lines included in the analysis.
- The average IDR award for procedures studied was nearly $40,000, compared with average benchmark rates based on in-network commercial payment or Medicare prices that ranged from approximately $645 to $1,600.
- The median IDR award was more than 50 times the median in-network contracted rate for the same service in the same market.
- Awards for these procedures increased 43% between 2024 and 2025.
“These findings raise important questions about how the process is functioning and suggest that additional safeguards are needed to help keep healthcare costs affordable,” said Aliza Gordon, director of research at the institute and co-author of the study. Gordon adds that policymakers should consider changes to the law to ensure the dispute resolution process remains focused on the situations it was originally designed to address while continuing to protect patients.
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