A new investigation from New York Times details how certain out-of-network providers have “flooded the arbitration system with millions of claims” under the No Surprises Act’s Independent Dispute Resolution (IDR) process—often “collecting fees hundreds of times higher than what they could negotiate with insurers directly or what they could have earned from patients before the law passed.”
While the reporting spotlights one plastic surgeon who alone has filed more than 6,000 arbitration claims and won more than 85 percent of them, the article makes clear this is not an anomaly.
Out-of-network providers are increasingly flooding the IDR process with disputes for routine, elective, and often ineligible procedures—winning nearly 90% of cases.
Below are key insights (emphasis added). To read the full article, click here.
The volume of IDR cases has vastly outpaced what Congress anticipated, and out-of-network providers are winning the overwhelming majority of disputes with extremely high awards.
- “When the law passed, government officials estimated that about 17,000 cases would go to arbitration a year. Instead, doctors brought 1.2 million such cases in the first half of last year, and won around 88 percent of them.”
- “Arbitrators have repeatedly approved doctors’ submissions of extremely high prices for common medical procedures… A neurosurgery practice outside of Philadelphia went to arbitration after the health plan Highmark offered its standard payment of $2,660 for a diagnostic procedure to measure blood flow to the brain. An arbitrator awarded it $333,000 instead.”
Providers are increasingly using IDR for routine and elective procedures that were never intended for the IDR process.
- “Medical specialties like spinal and plastic surgery, for which surprise bills were rare before the law, now frequently have cases in arbitration… Some practices are using the law to obtain high payments for routine medical care, including gynecologists who have won fees 600 times higher than usual rates for placing intrauterine contraceptive devices, or I.U.D.s.”
- “In the first case, in November 2024, Dr. Rowe won a payment of $112,500 that covered his work and the work of an assistant surgeon. In the fifth one, in late December 2025, his practice brought and won separate claims for each surgeon, totaling $440,000. Altogether, the practice won more than $1.4 million from those five surgeries alone.”
- “Elevance Health, another insurer, said that breast reduction surgeries are now its most expensive category of arbitration claims… one Connecticut plastic surgery practice has escalated its earnings from the procedure, beginning at $70,000 in 2024 and hitting $440,000 late last year.”
The system lacks meaningful guardrails, oversight, or accountability.
- “Many claims that shouldn’t be eligible for arbitration, such as those for patients covered through the government programs Medicare and Medicaid, move through the system anyway.”
- “Some argue that because the arbitrators are paid per case, they may have an incentive to render decisions that keep doctors coming back.”
The costs of this IDR dysfunction are being passed on to workers and families.
- “Some health plans said they have increased premiums this year to cover the extra costs. The United Service Workers health plan, which covers 20,000 trades workers in the New York area, said it boosted premiums by an extra 1.75 percentage points to offset arbitration awards and fees.”
- “The arbitrators are doing well too. The fees they earn for deciding cases, which range from $425 to $1,150 per case, have added up. They earned $885 million from 2022 to 2024.”
You can read the full New York Times article here. For more on how out-of-network providers are exploiting the IDR process, click here.
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