Quick Summary
- A new NBER working paper examines how the No Surprises Act’s federal IDR process may be affecting provider networks and insurance premiums
- Researchers estimate access to IDR reduced network participation among certain affected specialties by about 20%
- The study also suggests greater exposure to IDR may be associated with higher insurance premiums
- Federal data show providers continue to prevail in a large majority of IDR determinations
- The findings are preliminary and add to an ongoing debate over the broader effects of the federal IDR system
Study Examines IDR and Provider Networks
A new academic study is raising questions about whether the federal Independent Dispute Resolution process under the No Surprises Act may be changing providers’ incentives to participate in insurance networks.
Researchers Panle Jia Barwick, Anran Li, Tianli Xia, and Shizhe Yu analyzed federal arbitration data, provider network information, and Affordable Care Act marketplace plan data from 2017 through 2025. Their September 2026 National Bureau of Economic Research working paper concludes that network participation declined in specialties and states most affected by the No Surprises Act.
The researchers estimate that access to IDR reduced the likelihood that certain physicians, including emergency medicine physicians, radiologists, and anesthesiologists, would participate in health plan networks by approximately 20%.
Researchers Point to IDR as an Alternative to Network Contracts
Under the No Surprises Act, providers and health plans can use federal IDR to resolve qualifying out-of-network payment disputes when they cannot reach an agreement during open negotiation. A certified IDR entity ultimately selects one party’s proposed payment amount.
The researchers suggest that favorable IDR outcomes may strengthen the financial position of some out-of-network providers, potentially reducing the incentive to accept negotiated in-network rates.
Federal data show providers, facilities, and air ambulance providers prevailed in approximately 88% of IDR payment determinations during the first half of 2025. The prevailing offer also exceeded the Qualifying Payment Amount in approximately 88% of determinations.
Study Also Raises Questions About Premiums
The working paper found suggestive evidence that insurers with greater exposure to IDR increased premiums. The researchers estimated that the effects could translate into annual premium increases of approximately $183 for a 27-year-old and $322 for a 50-year-old purchasing coverage through the ACA marketplace.
However, the findings should be viewed in context. The paper has not yet undergone full peer review. In addition, a 2026 Government Accountability Office analysis found that in-network emergency medicine claims rebounded after the No Surprises Act took effect, which the GAO said may indicate increased provider network participation in that area.
What This Means for Healthcare Providers
The study adds another dimension to the continuing debate over federal IDR, provider reimbursement, network participation, and healthcare costs.
For providers, the findings underscore the importance of evaluating both in-network contracting opportunities and available out-of-network reimbursement strategies. IDR continues to be a significant tool for resolving qualifying payment disputes, but regulatory and legislative changes remain possible as policymakers assess how the system is functioning.
How Patriot Group Can Help
Patriot Group helps healthcare providers navigate the federal IDR process, evaluate eligible claims, challenge inadequate reimbursement, and develop strategies for payer disputes.
As the IDR landscape continues to evolve, providers should understand how changing rules, reimbursement trends, and payer strategies may affect their organizations.
