STAT’s Tara Bannow did a deeper dive into the extreme and exorbitant arbitration awards that are compounding the healthcare affordability crisis facing employers and Americans. Her latest story builds on the ongoing reporting from STAT, New York Times, Bloomberg, and others on the abuse and misuse of the No Surprises Act’s Independent Dispute Resolution (IDR) process and the wasteful spending that has ensued.
Highlights are included below (emphasis added):
- “When health insurers contract with providers, they agree on prices for all kinds of procedures. For a lumbar laminectomy, a common spine surgery for ailments like herniated discs or arthritis, the median price is $1,400.”
- “Out-of-network providers, those that don’t contract with health insurers, are getting 24 times that amount for the same surgery at the median — nearly $34,000 — through the No Surprises Act’s arbitration process. Some are even getting north of $100,000.”
- “A new dashboard produced by Turquoise Health, a company that specializes in price transparency data, illustrates just how lucrative the process has become for clinicians.”
- “Providers took home $9.8 billion in total awards across 5.3 million independent dispute resolution decisions between 2023 and the first half of 2025. About 12% of that amount, or $1.2 billion, was fees paid to the arbiters. IDR awards were about nine times the QPA for the same service in the same area, although, as with the lumbar laminectomy, some ran much, much higher.”
- “Another example of exorbitant payments are those for breast reduction surgery. For that procedure, Turquoise found the median in-network rate was $1,420, while the median IDR award was almost $61,000, or 43 times higher, with some awards extending above $180,000, in the first half of 2025.”
- “The New York Times recently profiled a New York surgeon whose practice once got $440,000 for that procedure under IDR. Turquoise found that breast reductions were one of the highest-volume surgical codes in federal arbitration, with about 2,700 cases and about $150 million in total payments to providers since 2023.”
- “One area Robbins said he sees unusually high IDR payouts is neuromonitoring, a procedure in which clinicians observe patients’ nervous systems during surgeries to prevent injuries. Since 2023, neuromonitoring providers have been awarded $325 million through IDR for a single code, CPT 95941, which represents one hour of neuromonitoring during surgery. The median in-network rate for that code is $307, and the median IDR award is about $5,100.”
Last week, nearly 50 groups representing employers, unions, patients, and consumers called on the Trump administration to investigate the independence and integrity of certified IDR entities that are awarding payment determinations as part of the IDR process. The groups assert that in light of the flood of ineligible claims and inflationary awards made in favor of certain private equity firms and out-of-network providers, there needs to be far greater oversight and investigation into their role in the process.
To read more, click here: https://stopsurprisebillingnow.com/arbitration/
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