“Without meaningful oversight and accountability, the IDR process will continue to reward manipulation rather than fairness.”
Over 60 employer, patient, and consumer organizations have called on the Trump administration to reform the No Surprises Act’s (NSA) independent dispute resolution (IDR) process, also known as arbitration, in order to protect patients – not private equity’s profits. Since its implementation, the IDR process has rapidly devolved into a costly scheme that benefits a small subset of IDR middlemen and other parties at the expense of patients, health plans, employers, and the broader health care system.
As the organizations emphasize in the letter, “the IDR process must serve as a backstop — not a pricing mechanism or profit-seeking tool… without necessary actions, misuse of the system will continue to raise costs for patients and undermine the affordability and stability of employer-sponsored coverage.”
Below are additional highlights from the letter:
- “Recent analyses indicate that the IDR process has incurred at least $5 billion in wasteful spending, including administrative fees, processing costs, and payment amounts that far exceed market rates, between 2022 and 2024.”
- “These costs have been driven in large part by the high volume of disputes and high provider use of IDR — primarily by four provider groups. These providers are overwhelming the IDR system with inappropriate claims — often for services not subject to IDR — or inflating billed charges to secure higher payouts.”
- “A core driver of these outcomes is the lack of clear, enforceable guidance requiring arbitrators to anchor decisions to market benchmarks. Current IDR operations allow arbitrators to depart from market benchmarks without meaningful explanation. When arbitrators do so, they should be required to clearly explain why, using the actual data submitted by both parties.”
- “A lack of accountability for IDR entities further compounds the problem. IDR entities face little consequence for issuing inconsistent, poorly reasoned, or statutorily misaligned decisions — even when patterns of extreme outcomes emerge.”
- “Entities with unusually high rates of rulings on clearly ineligible or out-of-scope cases should face corrective action, suspension, or loss of certification. Likewise, some IDR entities rule overwhelmingly — 95 to 98 percent or more — in favor of providers across payers and fact patterns. These IDR entities should be subject to prompt review.”
- “Without meaningful oversight and accountability, the IDR process will continue to reward manipulation rather than fairness.”
- “We are also concerned that the IDR process has expanded far beyond its intended scope. Planned and elective procedures at in-network facilities performed by in-network providers should be unequivocally excluded from the federal IDR process. These services at in-network facilities do not constitute surprise billing.”
- “IDR must remain a narrow safety valve — not a routine tool for setting prices for foreseeable, shoppable care.”
You can read the full letter here, as well as coverage in Bloomberg Law here. For more information on the No Surprises Act, visit: www.stopsurprisebillingnow.com.
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