How IDR Abuse Hits Americans’ Paychecks

Oct 13, 2026 | Arbitration, Blog Post

While the No Surprises Act largely succeeded in preventing consumers from receiving surprise medical bills, rising costs — amounting to more than $22.4 billion — generated by misuse and abuse of the law’s independent dispute resolution (IDR) process are cutting into workers’ paychecks.

Approximately 154 million Americans get health coverage through work, and two-thirds of covered workers are in self-funded plans. In these plans, the employer or union fund pays claims directly. Every IDR award comes straight out of the plan, and ultimately out of workers’ pockets — either through higher premiums contributions or reduced benefits, according to The ERISA Industry Committee (ERIC).

Below are some examples of IDR costs facing unions and employers:

The Congressional Budget Office (CBO) has even adjusted its projections on the impact of the No Surprises Act. CBO originally projected the No Surprises Act would cut premiums by about 1%. In June 2026, it warned that arbitration outcomes could instead push prices and premiums up.

The No Surprises Act’s patient safeguards should remain in place; it’s the law’s arbitration process that needs an overhaul and significant reforms. Congress can protect American workers from exorbitant IDR costs by:

  1. Reining in inflationary awards and runaway volume, which run counter to the law’s intent, by establishing clear guardrails ensuring IDR awards reflect market-based benchmarks, closing scope-of-services loopholes that allow scheduled and non-surprise care into the process, and requiring greater transparency and rationale in arbitration determinations.
  2. Stopping bad actors by automatically screening claims for eligibility through the IDR Gateway Portal before assigning an arbitrator and establishing upfront eligibility fees and meaningful penalties for providers with patterns of abuse.
  3. Enforcing accountability for IDR entities (IDREs) by establishing performance metrics that hold arbitrators accountable to the administration and the public and strengthening conflict-of-interest standards so that IDREs — at least five of which are private equity-backed — are truly neutral and independent.

To learn more, visit www.stopsurprisebillingnow.com/arbitration