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Employers are facing a big increase in the volume of health care payment fights flowing through the No Surprises Act dispute resolution system — a preliminary analysis shows employer plans that lose may pay more than 20 times, or even 40 times, as much as the typical in-network rate for care.
Private-sector plans were involved in 524,052 of the disputes reported to the Centers for Medicare & Medicaid Services in the second quarter of 2025, according to newly posted CMS data.
The number was up 119%, from 238,932, in the second quarter of 2024.
That total includes disputes over bills for:
◆ Emergency care that health plan participants received at out-of-network hospitals.
◆ Care from out-of-network providers that patients received while using in-network hospitals.
◆ Use of air ambulance services.
The number of disputes involving fully insured employer plans increased 111%, to 43,745.
The number involving self-insured employer plans rose 121%, to 195,187.
Payments: The CMS dispute resolution records express the final payment determinations as a percentage of the "qualifying payment amounts," or amounts typically paid for a service in an area to in-network providers.
Some records are incomplete or redacted.
The file for the second quarter of 2025 is now so big that getting all of the data into data-analysis software is difficult.
A preliminary analysis by BenefitsPRO of a sample of 1 million records for the second quarter of 2025 shows that, for records that had complete information about payment amounts, fully insured employer plans paid an average of 173% of the QPA, or about 1.73 times as much as the plans might have paid in-network providers.
Self-funded health plans that won paid an amount equal to 185% of the QPA.
When self-insured plans lost, the average amount paid was 23 times as high as the QPA.
When fully insured plans lost, the average amount paid was 44 times as high as the QPA.
The backdrop: Congress created the No Surprises Act system to get patients with health coverage out of the middle of many types of billing disputes between health plans and health care providers.
Plans have complained that they usually lose, and the payment amounts awarded tend to be much higher than the amounts paid to in-network providers.
Some patient advocacy groups have joined with benefits groups to ask Congress to change the system, saying it's driving up costs.
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