Independent dispute resolution arbitration under the No Surprises Act paid out nearly $15 billion in 2025, more than triple the $4.08 billion awarded in 2024. The No Surprises Act, enacted in 2020, was designed to shield patients from surprise balance bills when they receive emergency or certain non-emergency care at out-of-network providers in in-network facilities. However, the law's arbitration process has become dominated by health care companies filing disputes to extract higher payments rather than a tool protecting patients from balance bills. This shift affects how much you ultimately pay for insurance and care.
Table of Contents
- Providers Are Filing Most Disputes Now
- Awards Are Far Above Market Rates
- The Costs Ripple Through the Insurance System
- What Patients Should Know
- Frequently Asked Questions
Providers Are Filing Most Disputes Now
providers initiated approximately 957,960 of the 1.19 million disputes filed in 2025, or 81% of all cases, while insurers initiated only 131 disputes. This reversal shows the arbitration system has become a lever for large health care companies to appeal what insurers pay them—not a way to protect patients from unexpected bills.
According to analysis by the Center on Health Insurance Reforms at Georgetown University, just three staffing companies—HaloMD, TeamHealth, and SCP Health—filed nearly 38% of all disputes in the second half of 2025, suggesting the behavior is concentrated among a few large operators. The jump from $4.08 billion in 2024 to $14.85 billion in 2025 reflects both growth in dispute volume and the size of awards. Providers prevailed in approximately 85% of disputes in the second half of 2025, often receiving arbitration awards six times or more the local in-network payment rate.
Awards Are Far Above Market Rates
When arbitrators decide payment disputes, they are supposed to reference a "qualifying payment amount"—essentially a benchmark for what in-network providers in your area get paid. In 87% of 2025 arbitrations, the award exceeded that benchmark, often by a dramatic margin. An award six times the local rate means arbitrators are treating the arbitration process as a way to pay out-of-network providers at rates far above what the same service costs inside their own networks.
A CMS spokesperson acknowledged the problem directly: "the system is being gamed to get higher prices," and the agency is working to reform how arbitration payments are calculated. The current benchmarking system does not sufficiently limit what providers can request or what arbitrators award.
The Costs Ripple Through the Insurance System
Arbitration firms themselves collected approximately $1.3 billion in administrative fees in 2025 for handling these disputes, adding another layer of cost. The total annual cost of running the arbitration program exceeded $2.9 billion by 2025, including arbitrator fees, regulatory oversight, and legal costs providers incur to win these disputes. Insurers do not absorb these costs.
Studies show insurers pass arbitration expenses back to patients through higher insurance premiums, negating the original consumer benefit the legislation was supposed to deliver. A law passed to protect you from surprise bills ends up increasing what you pay every month for coverage.
What Patients Should Know
The No Surprises Act itself still protects you from balance billing in emergency situations and certain non-emergency services at in-network facilities. Providers cannot legally send you a surprise bill in those scenarios—the law works as written. The arbitration system, though, has become a way for providers and arbitration firms to extract higher payments from insurers, costs that flow back to patients.
When you receive a bill, check whether it was for emergency care or a service at an in-network facility. If either is true and you received a balance bill (a separate invoice from the out-of-network provider after your insurer paid), you may be able to challenge it by filing a complaint with your state insurance commissioner or the Centers for Medicare & Medicaid Services. The No Surprises Act protections are yours to use if the bill should never have reached you in the first place.
Frequently Asked Questions
Does the No Surprises Act still protect me from surprise bills?
Yes. The law itself still prevents balance bills for emergency care and certain non-emergency services at in-network facilities. The arbitration system that settles payment disputes between providers and insurers is what has been distorted—not your legal protections as a patient.
How does arbitration cost affect my premium?
Insurers pass the cost of arbitration disputes back to patients through higher insurance premiums. The system's $2.9 billion annual cost is ultimately paid by everyone with insurance, not absorbed by the insurers or providers who benefit from it.