A new Health Affairs article from Georgetown University’s Center on Health Insurance Reforms reveals how the Independent Dispute Resolution (IDR) process under the No Surprises Act has veered sharply off course, driving $5 billion in wasteful health care spending that ultimately hits employers and consumers. Instead of protecting patients, the process is inflating costs across the health care system.
Certain private equity–backed providers—the very same ones who contributed to the surprise billing crisis in the first place—continue to turn to IDR as a revenue-maximizing strategy, overwhelming the system with disputes—including ineligible claims—and demanding payments several times higher than in-network rates. The result is runaway spending, compounding inefficiencies and bad processes—all at the expense of patients and the broader health system.
Below are key insights from the analysis. To read more, click here.
- The IDR process generated at least $5 billion in total costs through the end of 2024.
- “Combining required fee payments, administrative costs, and additional payments for services, the IDR process has generated at least $5 billion—about $2 to $2.5 billion annually—in total costs through the end of 2024.”
- “Over the last two years, these costs have been driven by a high volume of disputes and high provider use of IDR––primarily by private equity backed groups”
- Disputes remain dominated by a few largely private equity-backed organizations across four states and providers continue to prevail with growing offer amounts.
- “In 2023 and 2024, 43 percent of resolved line-item claims were filed by two private equity-backed provider organizations: Radiology Partners and affiliates (28 percent) and Team Health (15 percent). The top five provider organizations were responsible for 59 percent of line-item claims.”
- “Alongside the continued dominance of these provider groups, middlemen organizations have grown in importance. In 2023, HaloMD accounted for 1 percent of line-item claims, and by the end of 2024, HaloMD was the fourth most active participant, with 6 percent of line-item claims.”
- “In 2024, providers won 85 percent of the line-item claims decided that year, up from 81 percent in 2023.”
- “Furthermore, providers have won substantial offer amounts. In Q4 2024, for line-items where the provider prevailed, the median payment determination was 459 percent of QPA. That means the provider requested, and won, a payment that was over four times the in-network amount.”
- “In disputes filed by HaloMD, the median amount was 934 percent of the QPA.”
- “From 2023-2024, 63 percent of all the decided line-item claims came from just four states: Arizona, Florida, Tennessee, and Texas. Over one-third of all claims (37 percent) came from Texas alone. This geographic skew appears driven by volume from the top provider organizations.”
- The volume of arbitration disputes continues to surpass agency estimates.
- “In the regulations establishing the IDR system, the federal agencies estimated that the IDR process would annually resolve 17,333 disputes, with an additional 4,899 disputes from air ambulance providers. The reality is far different: From mid-2022 to May 2025, 3,324,051 disputes were filed (including air ambulance disputes).”
To safeguard consumers from inflated arbitration outcomes and price gouging, the Coalition Against Surprise Medical Billing (CASMB) is urging the Trump administration to adopt common-sense reforms, including:
- Addressing persistent claim eligibility issues that lead to wasteful, exorbitant costs on ineligible claims by affirming claim eligibility for IDR and discouraging initiating ineligible disputes;
- Improving system transparency and oversight with enhanced information sharing and performance monitoring by:
- Enhancing access within the IDR portal and requiring transparent information sharing and rationales;
- Establishing IDRE performance metrics and audits tied to corrective action; and
- Monitoring and correcting longstanding provider misuse of the arbitration process that drives up employer and employee costs by developing a series of metrics to monitor problematic provider behaviors.
Read the full Health Affairs article online here. To learn more, visit https://stopsurprisebillingnow.com/.
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