Nearly 70 organizations representing employers, patients and labor unions have asked congressional leaders in both chambers to address what they call loopholes in the No Surprises Act. In a letter sent to House and Senate leaders, the coalition acknowledged the law’s role in preventing millions of surprise medical bills but argued that problems with the independent dispute resolution (IDR) process are now contributing to higher health care costs.
The letter focuses on the IDR mechanism — a baseball-style arbitration used when payers and providers cannot reach an agreement. Signatories say the number of IDR cases has far outpaced federal projections and that payouts to providers have climbed alongside that growth. They also describe a pattern of concentrated activity, saying a small number of provider organizations and newly emerged IDR middlemen are responsible for a large share of disputes.
According to the letter, key concerns include rising case volume, escalating payouts and strategic behavior by certain providers and intermediaries. The groups contend that these dynamics create incentives for repeat use of IDR rather than negotiated payment agreements.
The letter cites a recent analysis from researchers at Georgetown University that estimated IDR-related costs topped $22 billion in 2025. The signatories note that amount could be even higher for the current year, though the letter did not report a specific updated figure.
They argue that, given the high win rates and payouts for organizations that bring large shares of IDR cases — many reportedly backed by private equity — those entities have little reason to change their approach under the current system.
The groups frame their request as protecting both patients and the broader health insurance market. They write that Congress must act to “close these costly IDR loopholes to ensure that patients, consumers, and employees remain protected from unexpected out-of-network bills—and that health insurance premiums are not driven higher as a result of abuse of the arbitration process.”
Although patients cannot be billed directly for surprise out-of-network services under the law, the coalition emphasizes that rising IDR-related costs can be shifted to consumers indirectly. Insurers and plan sponsors facing higher payouts may seek ways to offset those expenses, potentially through increased premiums.
The letter urges lawmakers to replace the current baseball-style arbitration model with a more predictable and transparent benchmarking model. The groups argue a benchmarking approach would provide greater clarity and certainty to patients, payers and providers.
They also call for the establishment of a fair, market-based payment methodology aimed at reducing opportunities for gaming the system and preventing excessive reimbursement. Specific design details for the benchmarking or market-based methods were not provided in the letter, according to the submitted document.
The letter joins other signs of heightened scrutiny of IDR. The source notes related reporting that Rep. Frank Pallone has been probing No Surprises Act arbiters amid concerns about IDR costs and volume. Advocates and policymakers have debated how to preserve the law’s protections against surprise bills while limiting unintended cost consequences tied to arbitration.
Supporters of the No Surprises Act point to its primary consumer protection goal: shielding patients from catastrophic out-of-network charges. The coalition acknowledged that the law has protected millions of consumers but said its “central promise of protecting patients while lowering costs has been broken.”
If Congress pursues the changes advocated in the letter, payers, providers and employers could see shifts in negotiation dynamics and payment expectations. A benchmarking system would aim to standardize adjudicated payment levels, while a market-based payment method would seek to tie reimbursements more closely to prevailing rates.
The letter implies that such reforms could reduce the incentive for concentrated IDR activity by organizations that have been successful under the current process. It also suggests that reforms could help limit the downstream effect of arbitration-driven costs on insurance premiums.
The coalition’s letter calls for legislative reform but does not lay out precise statutory language or a comprehensive blueprint for implementing benchmarking or market-based payments. The Georgetown University estimate of $22 billion in 2025 is cited as evidence of scale, and the groups assert that the total could be higher for the current year, though no additional figures were provided in the filing.
The groups asked House and Senate leaders from both parties to address the issue; the source did not report whether lawmakers have responded or outlined any specific legislative proposals as of the letter’s submission. Lawmakers and regulators who weigh changes will need to balance maintaining patient protections with measures intended to curb rising arbitration-related costs.
For now, the coalition’s letter adds to ongoing discussions about how best to refine the No Surprises Act’s dispute resolution mechanisms without undoing the consumer protections that remain central to the law.
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