IDR Was Projected to Handle 17,000 Disputes a Year. Now, It’s Over 7,000 a Day.

When Congress passed the No Surprises Act, the independent dispute resolution (IDR) process was intended to settle occasional payment disputes between providers and health plans. Regulators originally estimated that the process would handle 17,000 disputes a year.

In 2025, 2.7 million disputes were filed. That’s more than 7,000 every day, or approximately 160 times the volume the system was designed to handle. After a new federal rule slashed the administrative fee for initiating a dispute from $115 to just $15, nearly 400,000 disputes were filed in July 2026 alone — a 24% increase from June 2026, according to bimonthly reports from the Centers for Medicare and Medicaid Services. At that pace and volume, initiated disputes totaled nearly 13,000 a day, close to double the 2025 pace.

Every Dispute Carries a Price Tag

As the number of disputes going through IDR increases, the costs skyrocket:

• $1.3 billion in arbitration fees in 2025, more than the $885 million spent from 2022 through 2024 combined.
• ~$15 billion awarded to providers by IDR entities in 2025.
• $22.4 billion in total costs linked to the IDR process over just four years.

These costs drive up the premiums that families and employers pay. For example, New York State’s Empire Plan named arbitration payments as the main driver of its 10% premium increase this year. As open enrollment begins, more families will feel the cost of provider-led IDR abuse.

Urgent Need for Congressional Action

House Energy and Commerce Committee Ranking Member Frank Pallone Jr., one of the No Surprises Act’s original authors, recently introduced the Lower Premiums, Faster Payments Act, stating, “I knew [arbitration] was not going to go well, but I didn’t know it was going to be this bad.”

The ongoing affordability crisis from IDR abuse and misuse requires congressional action. CASMB urges Congress to act on reforms that ground awards in reasonable, market-based payments, keep ineligible disputes out of IDR, and strengthen arbitrator oversight and accountability while preserving patient protections.

Congress must act to ensure the law delivers its full promise: protecting patients from surprise medical bills and lowering healthcare costs for employers, consumers, and families.

Learn more about the flawed arbitration system here.