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Benefits groups have joined with unions and patient advocacy groups to ask federal regulators to fix the No Surprises Act claim review system.
Congress passed the act in an effort to get patients with health coverage out of the middle of some types of fights between health plans and health care providers.
The affected providers are supposed to send the disputed claims to "independent dispute resolution" system reviewers, instead of sending huge bills based on sky-high out-of-network prices to patients who thought they were getting in-network care.
But "the IDR process is increasingly being used in ways that raise costs for patients, plan sponsors, health plans and the broader health care system," according to the groups that signed the letter.
The groups told federal health coverage regulators that:
◆ Some providers are flooding the IDR system with claims that are clearly not eligible for the IDR process.
◆ The IDR arbitrators do not have to explain their decisions.
◆ Providers win a majority of the disputes, and some arbitrators rule in favor of the providers more than 95% of the time.
◆ Rulings in favor of the providers lead to payments that are four times higher than the typical commercial payment rates for the same services in the same markets.
Federal regulators should exclude elective procedures from the IDR process, make the arbitrators explain their rulings, and establish oversight over the IDR entities that handle the disputes, the groups said.
The list of organizations signing the letter included a long list of national, local and regional benefits, employer and insurance groups, such as the American Benefits Council, the Council of Insurance Agents & Brokers, Elevance Health, the ERISA Industry Committee, the National Alliance of Healthcare Purchaser Coalitions and the Self-Insurance Institute of America.
The list of groups supporting the letter also included the AFL-CIO, the ALS Association, the Sjogren's Foundation and U.S. PIRG.
Robert F. Kennedy Jr., the secretary of the U.S. Department of Health and Human Services, shares responsibility for federal commercial health insurance regulation with U.S. Treasury Secretary Scott Bessent and U.S. Labor Secretary Lori Chavez-DeRemer.
The groups that signed the letter addressed it to Kennedy, Bessent and Chavez DeRemer.
The backdrop: The No Surprises Act applies to insured patients who get care from out-of-network doctors in in-network hospitals, to insured patients who get emergency care at out-of-network hospitals and to insured patients who use air ambulance services.
New studies from the U.S. Government Accountability Office and a team at the U.S. Department of Health and Human Services show that the percentage of patients getting care out of network dropped after the No Surprises Act system took effect, because plans tried to avoid IDR disputes by expanding their networks.
Since the system took effect, the payment amounts allowed by plans have increased for hospitals and other facilities and decreased for plans.
The groups that signed the new letter cited an estimate from a study published in Health Affairs in August 2025 that the IDR system added $5 billion in extra health care costs from 2022 through 2024.
ERIC's perspective: Melissa Bartlett, a senior vice president of health policy for ERIC, said in a comment that some out-of-network providers are turning the IDR system into a profit engine.
"Stronger federal guardrails are essential to prevent ongoing abuse," Bartlett said.
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