Quick Summary
- New research from the Elevance Health Public Policy Institute examines how the federal Independent Dispute Resolution (IDR) process is affecting reimbursement for certain planned procedures.
- The study found providers prevailed in nearly 90% of the payment disputes analyzed.
- Researchers reported that many IDR awards significantly exceeded typical in-network commercial and Medicare payment rates.
- Elevance argues the findings suggest the IDR process is contributing to higher healthcare costs for some scheduled procedures.
- The report is likely to fuel ongoing debate over potential reforms to the No Surprises Act (NSA).
New Research Raises Questions About the Federal IDR Process
The No Surprises Act was enacted to protect patients from unexpected medical bills while creating a fair process for resolving payment disputes between insurers and out-of-network providers. Since taking effect in 2022, the law’s Independent Dispute Resolution (IDR) process has become a critical reimbursement tool for healthcare providers.
A new study released by the Elevance Health Public Policy Institute, however, argues that the federal arbitration process may be producing unintended financial consequences for certain scheduled medical procedures. According to the report, the volume of IDR disputes has grown well beyond initial federal projections, prompting renewed discussion about whether additional changes to the process may be warranted.
Study Examines Planned Procedures
The analysis reviewed more than 7,300 payment disputes involving procedures typically scheduled in advance, including spine surgery, plastic surgery, colonoscopies, and other non-emergency services performed by out-of-network providers at in-network facilities.
According to the study:
- Providers prevailed in 89.5% of disputed claim lines.
- The average IDR award approached $40,000 per dispute.
- Median arbitration awards were reported to be more than 50 times higher than comparable in-network contracted rates.
- Award amounts for the procedures studied increased 43% between 2024 and 2025.
Elevance contends these findings demonstrate that the dispute resolution process is being used in ways that extend beyond Congress’s original intent and may ultimately contribute to higher healthcare costs for employers and health plans.
Ongoing Debate Over the No Surprises Act
While insurers point to these findings as evidence that reforms are needed, many provider organizations continue to argue that the IDR process remains necessary because health plans frequently make initial reimbursement offers well below fair market value.
Healthcare providers have also expressed ongoing concerns regarding delayed payments, enforcement of IDR awards, Qualified Payment Amount (QPA) calculations, and payer compliance with existing NSA requirements. Several medical societies have urged federal regulators to improve transparency and enforcement rather than reduce provider protections.
As a result, discussions surrounding the future of the No Surprises Act are likely to continue as policymakers balance patient protections, provider reimbursement, and healthcare affordability.
What This Means for Healthcare Providers
Although the study reflects one payer’s perspective, it signals continued scrutiny of the IDR process and the possibility of future legislative or regulatory changes. Providers should continue preparing well-supported IDR submissions, maintaining thorough documentation, and monitoring developments that could affect reimbursement strategies under the No Surprises Act.
How Patriot Group Can Help
The No Surprises Act and the federal IDR process continue to evolve as payers, providers, and regulators debate reimbursement policies and potential reforms. Patriot Group helps healthcare providers evaluate out-of-network claims, prepare strong IDR submissions, navigate payer disputes, and strengthen reimbursement strategies while maintaining compliance.
If your organization has questions about the No Surprises Act, IDR eligibility, or payer reimbursement challenges, Patriot Group is available to help.
