48 Groups Want Trump Administration To Improve Process to Resolve Payer-Provider Disputes - MedCity News

The No Surprises Act protects patients from unexpected bills by requiring insurers and providers to negotiate payment terms for out-of-network services for 30 days. If no agreement is reached, either party can use an independent dispute resolution process in which providers submit payment offers, insurers submit payment offers, and a neutral arbitrator selects one. A coalition of 48 employer and consumer organizations urged the Trump Administration to strengthen oversight of certified IDR entities. The groups said the process is being exploited by a small number of providers through coordinated, high-volume filings rather than last-resort dispute resolution. They reported that providers win about 88% of cases and receive payments 300% to 900% above the median in-network amount, increasing premiums, deductibles, and out-of-pocket costs.

"The No Surprises Act protects patients from unexpected bills and removes them from insurer-provider payment friction. The act requires insurers and providers to enter into 30 days of open negotiation to determine how much providers are paid. If they can't come to an agreement, either side can use the independent dispute resolution process, in which a provider submits a payment offer and an insurer submits a payment offer and then a neutral arbitrator (called an IDR entity) picks one."

"The letter was submitted last week to the Departments of Treasury, Health and Human Services and Labor. The signatories include the American Benefits Council, Families USA, the National Alliance of Healthcare Purchaser Coalitions, the Purchaser Business Group on Health and the ERISA Industry Committee. In the letter, 48 employer and consumer organizations called on the Trump Administration to strengthen oversight of certified independent dispute resolution (IDR) entities."

""This is not organic dispute resolution," the organizations said. "It is a coordinated, high-volume strategy being systematically exploited by a small number of bad actors at the direct expense of American employers, workers, and families." The letter added that providers win about 88% of IDR cases with payments that are 300-900% of the median in-network amount."

"The process was intended to be a "last-resort backstop" for resolving disputes between health plans and out-of-network providers, initially projected to have 17,000 arbitration cases a year, according to the letter. But in just the first half of 2025, there were over 1.2 million cases. These costs are then passed on to consumers via higher premiums, deductibles and out-of-pocket expenses."

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