Health plans found that 39% of provider’s surprise billing disputes were ineligible for arbitration and never should have been submitted to the federal independent dispute resolution process, according to a survey published Oct. 24.
The No Surprises Act established the IDR process, with one Health Affairs study reporting it cost $5 billion since 2022. From March to May 2025, the trade group America’s Health Insurance Plans and the Blue Cross Blue Shield Association fielded responses from 25 health plans with enrollment in the commercial market. The plans provided data on their 2024 qualified IDR claims.
The survey said these ineligible claims included ones payable under Medicare or Medicaid, claims that were already resolved, disputes with in-network providers and claims subject to a state’s surprise billing legislation.
The organizations called out IDR entities — the arbiters — for their responsibility with determining claim eligibility. The survey said IDREs have a financial incentive to move forward with disputes, “even when the dispute fails to meet all criteria.” The survey found IDREs determined only 17% of disputes were ineligible, significantly less than the plans’ survey finding of 39%.
“With no avenue for health plans to appeal or even review eligibility or payment determinations, IDREs have largely unchecked authority to mandate payments from health plans beyond the scope of the law — even if the claim should never have been submitted,” the survey said.
In September, the HHS, and the departments of Labor and the Treasury said they “have taken steps to resolve these capacity issues and clear the IDR backlog” over the past year. One step they took was to use automated validations to limit the progress of ineligible disputes.
