Just a Minute! on The Unsurprising Flaw in the No Surprises Act

October 31, 2025

Five years after the enactment of the No Surprises Act – the measure intended to prohibit “surprise” medical billing, the Council’s concerns about the law’s arbitration-based independent dispute resolution (IDR) system have sadly been proven right.

So far, the arbitration system has been challenging to navigate, with health care providers prevailing 85% of the time and median payment determinations over 450% of the median in-network rate. These problems stem from much higher volumes of claims being sent to arbitration, many of which are ineligible for IDR (roughly 20% were ruled ineligible according to the most recent CMS data) and IDR entities issuing unlawful payment determinations on some non-qualified IDR claims (A recent survey released by AHIP and BCBSA estimates nearly 40% of claims are ineligible for IDR.)

In the latest edition of Just a Minute!, Council President Katy Johnson explains how these fundamental IDR issues are raising concerns about increased costs for plans and participants. We welcome input from Council members as we advocate for changes to the system, as part of our own priority policy agenda and as a founding member the Coalition Against Surprise Medical Billing (CASMB).

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