Research finds arbitration awards for certain planned procedures are often far higher than typical in-network payment rates
INDIANAPOLIS, June 25, 2026--(BUSINESS WIRE)--The No Surprises Act was created to protect patients from unexpected medical bills. While those patient protections are working, new research from the Elevance Health Public Policy Institute suggests that the law's payment dispute process is producing unexpected results for some planned medical procedures.
The findings come as federal IDR volume has grown far beyond initial projections, raising concerns that a process intended as a limited payment-dispute backstop is increasingly contributing to higher out-of-network costs.
The study examined more than 7,300 payment disputes involving procedures and services that are typically scheduled in advance, such as spine surgery, plastic surgery, colonoscopy, and other scheduled services. These procedures qualified for the dispute resolution process because they were performed at in-network facilities by out-of-network providers. Researchers found that providers won nearly 90 percent of disputed claim lines and that payments awarded through the federal Independent Dispute Resolution (IDR) process were often tens to hundreds of times higher than typical in-network commercial rates and Medicare payment rates.
"The No Surprises Act was designed to protect patients from unexpected medical bills, not to increase healthcare costs," said Catherine Gaffigan, MD, president, health solutions at Elevance Health. "Our Public Policy Institute's research raises serious concerns that the dispute resolution process is being used for certain scheduled services in ways that diverge from the law's original intent. When the system is exploited, the result is higher costs for employers and families who ultimately bear the burden through higher premiums and healthcare expenses. Preserving patient protections requires ensuring that the dispute resolution process is used appropriately and functions as Congress intended."
The No Surprises Act took effect in 2022 and protects patients from many surprise medical bills when they receive out-of-network care. When insurers and providers cannot agree on payment for services covered by the law, either side can bring the dispute to an independent arbitrator.
When most people think about surprise medical bills, they think about emergency care or situations where a patient has little control over who provides treatment. This study focused on a different set of cases: planned procedures scheduled in advance with an out-of-network provider at an in-network facility, which later became the subject of payment disputes.