Arizona providers could face license suspension or revocation for submitting too high of payment offers during No Surprises Act arbitration under a newly proposed bill in the state’s legislature.
The bill would cap what physicians and nurses can ask for during the independent dispute resolution process at 300% of Medicare rates or 300% of the qualified payment amount. Providers who exceed either threshold would be deemed to have charged an excessive fee, exposing them to disciplinary action from their respective licensing board, including possible license revocation.
The bill includes two exceptions: cases where the provider and patient entered into a written contract for a fixed fee before the service was provided, and cases where the patient gave consent to waive NSA protections. It also includes a provision directed at insurers, requiring plans to pay arbitration awards within a 30-day window.
BCBS Arizona and Cigna are the only registered supporters of the bill. There are 148 registered opponents, including the Arizona Medical Association, Arizona Nurses Association and other provider and hospital groups.
The legislation comes as the IDR process continues to be a source of controversy nationwide. Research points to at least $5 billion in spending on the process since 2022. In January, CMS released IDR data from the first and second quarters of 2025, showing providers won 88% of disputes in the first half of the year. Providers initiated the majority of disputes, accounting for 81%, of the 1.19 million total filed. Texas led all states with 456,162 dispute initiations, followed by Arizona.
Of all the payment determinations in the first half of 2025, nearly 88% of offers exceeded the qualifying payment amount.
