Dive Brief:
- Nearly 50 groups representing employers, unions and patients are urging the Trump administration to reform the independent dispute resolution process under the No Surprises Act.
- In a letter sent to HHS Secretary Robert F. Kennedy Jr. and the secretaries of the Treasury and Labor Departments last Thursday, the groups argued bad actors are filing large numbers of payment disputes and driving up healthcare costs for payers and patients.
- Certified IDR entities, those tasked with resolving disputes, face “structural conflicts of interest” given they only get paid when they issue determinations and are paid per case, the groups wrote. “Unfortunately, this structure directly incentivizes volume over impartiality,” they wrote.
Dive Insight:
The No Surprises Act went into effect in 2022 as part of an effort by lawmakers to protect patients from unexpected out-of-network medical bills.
Under the dispute resolution process set up by the law, insurers and providers file what they think is a fair price if they can’t come to an agreement on payment. Then a third-party arbiter certified by the government, called an IDR entity, selects an offer.
While the No Surprises Act has been successful at preventing surprise medical bills for patients, IDR has been dogged by complaints from both insurers and providers that the process unfairly favors the other party.
Meanwhile, arbiters are handling significantly more disputes than anticipated, reaching nearly 1.2 million cases in the first half of 2025, according to CMS data cited in the letter viewed by Healthcare Dive.
The vast majority of disputes are won by providers, and they can win payments worth significantly more than the in-network amount, wrote the groups, which include the American Federation of State, County and Municipal Employees; the ERISA Industry Committee; and the Purchaser Business Group on Health.
When arbitration awards are consistently high, “those costs are passed on to consumers through higher premiums, higher deductibles, and higher out-of-pocket expenses,” they said.
IDR entities have conflicts of interest in the process too, the groups argued. At least one arbiter is backed by a private equity firm that also invests in a provider that files payment disputes, according to research by the Private Equity Stakeholder Project cited in the letter. PE-backed providers also initiated a significant portion of IDR disputes in the first half of 2025, according to CMS data.
The Trump administration should investigate the independence of IDR entities, especially those supported by private equity or with ties to providers with a high volume of disputes, the groups wrote in the letter.
Additionally, arbiters should be required to publicly disclose their ownership structures, and the federal government should decertify entities with conflicts of interest. The Trump administration also should put eligibility screening in place to tamp down on the number of ineligible claims being filed, the groups said.
