The top Democrat on the House Energy and Commerce Committee is seeking information from six companies that arbitrate billing disputes under the No Surprises Act amid reports that the process is ballooning administrative costs and driving up insurance premiums.
Rep. Frank Pallone Jr. (D-N.J.) sent oversight letters Sept. 3 to C2C Innovative Solutions, Commence, Dane Street, EdiPhy Advisors, National Medical Reviews and ProPeer Resources. All six had ignored earlier informal requests for briefings, according to Mr. Pallone’s office.
Mr. Pallone, a key author of the 2020 law, said the IDR process is no longer working as Congress intended – federal regulators had originally projected about 17,000 disputes a year, while the actual number hit 2.5 million in 2025. Ten filers account for roughly 67% of all cases, with Mr. Pallone saying that most are private equity-backed provider groups.
Providers won more than 85% of arbitration decisions last year at amounts averaging more than six times local in-network rates, producing roughly $15 billion in total awards in 2025. Some emergency services awards reached 500% of Medicare rates, and imaging awards hit 800%.
The letters ask each firm to turn over documents by Sept. 24 on dispute volumes and eligibility screening, staff training and pay structures, use of AI in the arbitration process, internal auditing, the identities and win rates of their highest-volume filers, and any financial ties between the firms and the parties whose disputes they handle.
The probe comes amid a string of insurer lawsuits alleging providers are flooding the system with ineligible claims. Provider and physician groups have countered that insurers are submitting lowball offers and delaying payments they owe after losing arbitration.
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