The No Surprises Act’s arbitration process awarded close to $15 billion to out-of-network providers in 2025, more than three times the prior year’s total, according to a Wall Street Journal analysis of federal data.
Payouts through the independent dispute resolution process reached $14.85 billion in 2025, up from $4.08 billion in 2024, the Journal reported. Arbitration firms collected about $1.3 billion in fees last year.
“This law is critical for protecting patients from receiving surprise bills,” a CMS spokesperson told the newspaper. “While patients are now protected from surprise bills, the system is being gamed to get higher prices, and CMS is actively working to clean it up.”
The No Surprises Act, enacted in 2020, shields patients from unexpected bills for out-of-network emergency care and certain other services and routes the resulting payment disputes into arbitration.
CMS posted the third- and fourth-quarter 2025 arbitration data July 22. Certified entities issued about 2.2 million payment determinations last year, with more than 1.1 million of them in the second half, according to CMS. Disputing parties initiated about 1.4 million disputes from July through December, a 16% increase over the first six months of the year. Providers, facilities and air ambulance services prevailed in about 85% of second-half determinations, and the prevailing offer exceeded the qualifying payment amount in roughly 87% of cases. The three most active filers, HaloMD, TeamHealth and SCP Health, accounted for about 38% of disputes initiated in the second half.
The figures come as insurers have been intensifying their rhetoric against the IDR system. On July 16, Dan Kueter, CEO of UnitedHealthcare’s commercial business, said the process “is not working” and “needs to be reformed,” describing it as exploited by certain providers. He said arbitration now accounts for at least 100 basis points of the company’s total commercial cost. UnitedHealthcare told Becker’s it is seeing roughly 100,000 disputes a month, far above the roughly 22,000 a year CMS originally projected for the entire industry when the process launched.
Over the last few months, federal courts have largely rebuffed insurers’ claims that providers are gaming the process. Earlier this month, a federal judge dismissed with prejudice an Elevance Health lawsuit accusing billing firm HaloMD and two physician groups of defrauding its Blue Cross Blue Shield of Georgia plan through arbitration. Judges in California and Texas threw out similar suits against HaloMD in April and May.
The Trump administration finalized an overhaul of the process in late May, establishing a centralized disputes portal, creating a federal payer registry and cutting per-dispute administrative fees from $115 to $15.
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