A new analysis published in Health Affairs offers an early look at Q1-Q2 2025 data from the No Surprises Act’s federal Independent Dispute Resolution (IDR) process, finding that “the volume of cases submitted into the IDR process continues to exceed all expectations.”
The latest analysis reinforces that the system’s dysfunction is only deepening. Dispute volume in the first half of 2025 more than doubled compared to the same period in 2024, and a handful of private equity-backed providers and IDR middlemen continue to dominate the process and secure payouts far above in-network rates – often 3-9x more.
Further, accelerating administrative costs mean the $5 billion in excess IDR costs already generated through 2024 will have risen substantially by year’s end, with those costs passed on to employers and families through higher premiums, deductibles, and out-of-pocket expenses.
Below are key insights from the analysis (emphasis added). To read more, click here.
Private equity-backed providers and IDR middlemen are exerting outsized influence, effectively controlling dispute outcomes and rigging the system in their favor.
- “In the first six months of 2025, providers and facilities initiated 99.9 percent of all disputes while plans initiated 0.01 percent. Of the provider-initiated disputes, 80 percent were submitted by providers while 20 percent were submitted by facilities.”
- “Four provider groups and provider representatives—mostly backed by private equity—initiated the majority of these disputes: HaloMD, Team Health, Radiology Partners, and SCP Health. HaloMD—a middleman organization that specializes in arbitration—initiated the most disputes, accounting for 17 percent of all disputes in the first quarter of 2025 and 22 percent of all disputes in the second quarter of 2025.”
- “Providers also won 88 percent of disputes—the highest provider win rate to date—as compared to 85 percent in 2024 and 81 percent in 2023. Radiology Partners prevailed most often, winning favorable IDR awards in 92 percent and 95 percent of its cases in the first two quarters of 2025, respectively.”
Providers continue to reap outsized awards through the IDR process, perpetuating further abuse.
- “For the first two quarters of 2025, Radiology Partners secured median awards of 582 percent and 594 percent of QPA, respectively. SCP Health won median awards of approximately 370 percent of QPA in both quarters, and Team Health won award amounts at a median of 277 percent of QPA.”
- “Of the top four initiating parties, HaloMD’s award amount far outpaced the others, with median payments of 920 percent and 835 percent of QPA in the first two quarters of 2025, respectively.”
- “To the extent that the QPA accurately represents median in-network rates, these results indicate that certain provider groups are receiving three to nine times in-network rates.”
The number of IDR disputes continues to grow at an unprecedented pace, causing administrative and system-wide costs to skyrocket.
- “During that period, parties submitted 1.2 million new disputes to the IDR portal—more than double the volume of the first two quarters of 2024when nearly 590,000 disputes were filed. This amounts to a total of 4 million disputes from 2022 through June 2025.”
- “The ever-increasing volume of cases has contributed to higher administrative costs… In the first half of 2025, these fees totaled $844 million. This amount is staggering on its own. But it is even more alarming that this amount—for a six-month period—is nearly equivalent to the total of $885 millionin administrative fees from 2022 to 2024.”
- “The high fee amount in just six months suggests that IDR-related administrative costs are escalating quickly and that our prior estimate of $5 billionin total IDR-related costs through the end of 2024 will have risen substantially by the end of 2025.”
You can read the full article from Health Affairs here. For more on how some private equity-backed providers and IDR middlemen are exploiting the IDR process, click here.
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