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The independent dispute resolution services that handle fights over No Surprises Act claims decided 225,795 cases involving physicians who billed for "emergency department visits with a moderate level of medical decision making" in the second quarter of 2025.
The IDR services ruled in favor of the providers 85.5% of the time, according to a new, free IDR award-tracking dashboard posted by Turquoise Health.
The median national award for a provider who won a dispute with a commercial health plan over a medium-intensity ER bill was $795. The median amount that commercial plans paid for the same service in the same markets was just $140.
The figures mean that the IDR awards increase commercial plans' billed claim totals for the providers that won by a total of $637 million.
For an ER visit with a low level of medical decision making, hospitals won 87.5% of the 18,282 IDR decisions reported. The hospitals that won received a median award of $2,769, compared with a median in-network market rate of $738. Those awards increased the commercial plans' costs by about $420 million.
The difference between the market rate and the IDR rate was much bigger for a less common kind of dispute: fights over how much hospitals can charge for an hour of patient observation time. IDR services ruled in favor of the hospitals in the 454 cases involving that kind of charge 86.4% of the time.
The median in-network rate for that was $86, and the median award was $19,985. Those awards added about $11 million to commercial plans' costs.
Turquoise created the IDR award-tracking dashboard to help employers, benefits advisors, providers, patients and researchers use the data in the huge, hard-to-manage files that the Centers for Medicare & Medicaid Services uses to publish the IDR outcomes data.
Turquoise gives the median in-network payment amount and the median IDR award amount for each service, along with the Current Procedural Terminology code, for each of the 1,670 services in the data.
Users can see national data for each code. They can also see IDR outcomes data for each state and for each "metropolitan statistic area," or market area.
What it means: The new Turquoise dashboard will help employer groups, insurer groups, provider groups and others come up with the data they will use in the coming battles in Congress over whether and how the IDR system should be changed.
The history: Congress passed the No Surprises Act to try to find a way to protect commercially insured patients who do their best to follow plan rules but who might end up with unexpected balance bills, or surprise bills, for out-of-network care.
The act covers patients who get emergency care in out-of-network hospitals; patients who inadvertently see out-of-network providers in in-network hospitals; and patients who use air ambulance services.
Providers who disagree with insurers' or self-insured employer plans' payment offers in connection with those services are supposed to take the disputes to the IDR services, instead of sending bills for the disputed amounts to the patients.
Perspectives: Employer groups and groups like America's Health Insurance Plans have argued that the IDR system clearly favors the providers.
Health plans support reforms to "protect consumers and rein in provider-driven abuse that fuels higher costs for everyone," AHIP said Wednesday, in response to news reports based on Turquoise dashboard data.
Emergency room physicians have reported in online discussion forums that collecting IDR system awards is difficult, that medical services management firms handle much of the billing without physician input, and that giant, private-equity-owned practices appear to be filing and winning many more IDR claim disputes than small and midsize medical practices are.
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