The continued abuse and misuse of the Independent Dispute Resolution (IDR) process — and its growing associated costs — has become an untenable expense for millions of Americans and employers. Following the release of the recent IDR operations rule, members and partners of the Coalition Against Surprise Medical Billing (CASMB) hosted a congressional briefing to underscore the affordability crisis that has resulted from the defective IDR process.
New data from the Elevance Health Public Policy Institute, highlighted during the discussion, reinforced the ripple effect of IDR abuse and misuse, examining more than 7,300 payment disputes involving procedures and services typically scheduled in advance. The average IDR award for the procedures studied was nearly $40,000, compared with average benchmark rates based on in-network commercial payment or Medicare prices that ranged from approximately $645 to $1,600.
Participants also underscored broader affordability challenges facing multiemployer plans, companies, and consumers. Highlights from the discussion are below:
- Katie Keith, Founding Director, Center for Health Policy and the Law at the O’Neill Institute, Georgetown Law: “The No Surprises Act has successfully protected millions of patients from unexpected out-of-pocket costs. But the law’s implementation, which has been indelibly shaped by litigation over the IDR process, has run into real cost and volume challenges that Congress did not anticipate. While federal officials expected about 17,000 IDR disputes, providers have filed the vast majority of the more than 6.3 million disputes initiated as of May 2026. This volume has contributed to about $5 billion in IDR-related costs through the end of 2024 alone—with far higher costs expected for 2025 and beyond. If left unaddressed, this financial burden will only further balloon and ultimately be borne by the consumer.”
- Aliza Gordon, Director of Health Services Research, the Elevance Health Public Policy Institute: “According to our latest research, IDR awards for certain planned procedures – such as plastic or spine surgery – are averaging more than 50 times in-network commercial and Medicare benchmark rates. Policy changes that limit IDR eligibility of planned services to cases where patients could not reasonably consent to costs, reinforce market-based benchmarks, and increase transparency and accountability in IDR decision-making are needed. The No Surprises Act was intended to protect patients, not inflate costs. Without this targeted reform, the IDR process risks doing exactly that.”
- James Gelfand, President and CEO, The ERISA Industry Committee: “Congress’s promise to protect Americans from high medical bills is being undermined by the same Wall Street corporations that created the surprise billing crisis in the first place. These companies are gaming the system to the tune of $5 billion with costs continuing to rise, and now, after the recent rule lowered the associated dispute fee, we risk even more disputes. The recent rule was a missed opportunity, but Congress and the Trump administration still have the authority to end this gamesmanship, by increasing transparency and oversight into IDR entity decisions and re-establishing guardrails to protect patients’ best interests.”
- Katie Berge, Senior Director of Federal Affairs, Blood Cancer United: “For patients, a diagnosis can be not only physically and emotionally devastating, but also financially crushing. The No Surprises Act was built to protect patients from surprise bills and to drive down the overall cost of care, but the billions of dollars wasted by IDR don’t vanish into the ether. They show up in higher premiums, higher cost sharing, and higher deductibles. Until Congress acts, these exorbitant costs will continue to end up right back in the patient’s pocketbook.”
- Mariah Becker, Director of Research and Education, National Coordinating Committee for Multiemployer Plans: “An anesthesiologist who had been in-network with one of our member plans for years is now saying they need to accept higher costs, or the provider will run every claim through IDR. Through these types of ‘negotiations,’ IDR abuse is driving up costs across the spectrum, and it ultimately lands at the feet of the workers they are supposed to protect and their health plans.”
A full recording of the event is available here. Read the latest analysis from the Elevance Health Public Policy Institute here.
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