Coalition Urges White House to Tighten No Surprises Act Arbitration
Forty-eight employer and consumer groups urge White House reforms for No Surprises Act arbitration.
Why it matters: Payment disputes between providers and insurers have exploded under the No Surprises Act, raising costs and compliance risks for legal teams across the healthcare sector. More enforcement or regulatory changes could reshape payment negotiations and set new compliance expectations.
- A coalition of 48 employer and consumer organizations called on the federal administration May 14, 2026, to address alleged conflicts in the Act’s arbitration (IDR) process.
- The groups claim private equity-backed IDR entities have incentives to increase disputes and drive up payments.
- Between April 15, 2022, and March 31, 2023, 334,828 disputes were filed—14 times the government’s initial projections.
- Providers won in about 88% of recent arbitrations, often securing awards 300–900% above in-network rates; government data suggests a 71% win rate for initiating parties overall.
A coalition of 48 major employer and consumer groups—including the American Benefits Council, Families USA, and the ERISA Industry Committee—sent a joint letter to federal officials on May 14, 2026. They call for reforms to the No Surprises Act’s independent dispute resolution (IDR) process, arguing some certified arbitrators, especially those with private equity ties, benefit financially from more disputes and higher payment decisions.
- The No Surprises Act, enforced since January 2022, aims to eliminate unexpected out-of-network medical bills and mandates a federal portal for resolving provider-insurer disputes (official CMS guidance).
- The coalition alleges this surge in IDR filings—334,828 from April 2022 to March 2023—far exceeds projected case volume, straining the arbitration system (Department of Labor data).
- In that period, initiating parties, often providers, prevailed in 71% of cases according to government data; the coalition claims providers’ win rate recently reached 88%, with many awards ranging 3-9 times median in-network rates.
Physician advocacy groups, including the American Medical Association, counter that insurers also exploit loopholes, resulting in delayed or denied payments to providers, shifting costs and threatening smaller practices (AMA statement).
Legal and compliance teams must navigate rising scrutiny as policymakers weigh reforms on a law affecting multi-billion dollar hospital and insurance negotiations.
By the numbers:
- 334,828 — IDR disputes filed from April 2022 to March 2023, 14x initial estimates
- 88% — Reported recent provider win rate in IDR, far above prior projections
- 300–900% — Range above median in-network rates in some provider arbitration wins
Yes, but: Physician groups argue payers have undermined the Act, causing access and payment issues for doctors—suggesting enforcement challenges go both ways.
What's next: Federal officials are reviewing feedback from stakeholders; regulatory changes or new guidance could follow in the coming months.