The independent dispute resolution process created under the No Surprises Act has generated at least $5 billion in costs since its launch in 2022, largely due to high dispute volumes and provider wins, according to a study published Aug. 25 in Health Affairs.
The NSA was designed to prevent surprise billing by establishing the IDR process for payment disputes between insurers and out-of-network providers, mandating that disagreements be resolved through a neutral third-party arbitrator.
“The high volume of IDR disputes is generating significant spending from administrative costs and higher payments for services,” the researchers wrote. “This higher spending will likely be reflected in higher overall health costs and consumer premiums in the future.”
Six things to know:
1. Through administrative fees, the insurer and provider costs of managing disputes, and higher payments resulting from arbitration awards, researchers estimate the IDR process has added $5 billion in costs from 2022 to 2024. Administrative costs accounted for more than half at $2.8 billion.
2. In 2023 and 2024, IDR awards required insurers to pay providers $2.24 billion above the in-network rates reflected by the qualifying payment amounts. In many cases, awards were three to four times the QPA.
3. Federal regulators originally projected that about 17,000 disputes would take place annually. Instead, from mid-2022 to May 2025, more than 3.3 million disputes were filed, including air ambulance cases. As of May 2025, 85% have been closed, but nearly 500,000 disputes remain pending.
4. In 2024, providers won 85% of disputes. Median payment determinations were 459% of QPA in the fourth quarter of 2024, up from 327% in 2023. Some organizations, such as HaloMD, won awards at 934% of QPA.
5. Radiology Partners and Team Health accounted for 43% of resolved line-item claims in 2023 and 2024. The top five providers make up 59% of claims, with cases concentrated in Texas, Florida, Tennessee and Arizona.
6. In May, Elevance Health’s Blue Cross Blue Shield of Georgia sued HaloMD, Hospitalist Medicine Physicians of Georgia and Sound Physicians Emergency Medicine of Georgia, alleging the three organizations exploited the IDR process for financial gain. The lawsuit claims that the companies knowingly submitted thousands of ineligible disputes in an effort to receive inflated reimbursement payments.
