The Surprising State of the No Surprises Act – Independent Dispute Resolution Reform

When signed into law in 2020, the No Surprises Act (NSA) was designed to lower costs for patients and employers by addressing the issue of surprise medical bills. Unfortunately, the implementation of the law has proven to be the opposite of what employers, and Congress, expected.

Today, the NSA’s independent dispute resolution (IDR) process has actually increased costs as employers are seeing a flood of claims coming through reflecting a system that is heavily tilted in favor of providers.

The following is an expanding list of ERIC’s ongoing policy initiatives, as well as related resources and articles on NSA IDR.

Why Employers Care

While the No Surprises Act was intended to protect consumers and lower health care costs, its implementation has created unintended, costly consequences for employers sponsoring group health plans:

Escalating Employer Plan Costs: Employer plans directly absorb losses from IDR outcomes. Because decisions heavily favor one side, overall claims spending increases, driving up health care expenses for self-insured employers and raising insurance premiums for employees.
A Heavily Skewed System: The current arbitration process is overwhelmingly tilted toward providers, who win more than 85% of IDR cases, leading to a flood of high-cost disputes rather than fair, balanced settlements.
Systemic Financial Exploitation: Unintended loopholes in the arbitration rules allow out-of-network providers and medical groups to game the system, resulting in inflated reimbursements (such as surgical assistants or emergency facilities securing outsized payouts) that ultimately drain employers who are the ones stuck paying these bills.

ERIC will be issuing a white paper in more detail on our member companies’ experiences with the NSA IDR process.