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The No Surprises Act independent dispute resolution system is expensive, slow and usually favors the health care providers.
A team at the U.S. Department of Health and Human Services has published data supporting those conclusions in a new report on implementation of the IDR system.
About 85% of the disputes that flowed through the system in 2023 involved participants in health plans sponsored by private employers, the HHS team found.
◆ IDR reviewers took an average of 91 days to handle the disputes, and reviewers took more than 300 days to close some disputes.
◆ The reviews cost an average of $445 each.
◆ The reviewers sided with the providers in cases involving hospital care 80% of the time.
◆ When reviewers sided with the providers, they awarded very high payment rates.
For anesthesia for a colonoscopy, for example, health insurers paid providers an average of $300 in 2023.
When an IDR reviewer handled a dispute involving colonoscopy anesthesia, it awarded an average payment amount of $1,252.
For a pathologist's tissue examination, the average commercial payment amount was $51, and the average amount awarded by an IDR reviewer was $161.
The report: Analysts at the HHS Office of the Assistant Secretary for Planning and Evaluation created the report for Congress.
The HHS analysts used data files that are similar to the data files that Georgetown University researchers used to prepare a No Surprises Act impact report in August 2025.
One difference between the Georgetown report and the HHS report is that the HHS report is an official government document and is free from copyright protection.
Employers, benefits advisors and others can use the HHS data in their own reports and post copies of the report on their own websites.
The history: Benefits advisors have been trying for decades to protect patients from billing disputes between providers and payers.
The No Surprises Act tries to prevent some cases of balance billing by requiring providers and payers to resolve disputes over certain types of bills without sending big bills for out-of-network care to the patients.
The law affects patients who get emergency care at out-of-network hospitals; patients who use out-of-network providers, such as anesthesiologists or radiologists, at in-network hospitals; and patients who use air ambulance services.
Federal officials said at a Senate hearing in March 2023, when the No Surprises Act IDR system was new, that it was working poorly.
Some said Congress might have to step in to keep providers from filing barrages of ineligible claims and to require payers to comply with No Surprises Act response deadlines.
But analysts at America's Health Insurance Plans and the Blue Cross Blue Shield Association concluded in 2024 that the act has succeeded at shielding patients from many payer-provider billing disputes.
The act protects patients from about 1 million surprise bills per month, the analysts said.
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