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A Georgetown University study estimates the No Surprises Act's independent dispute resolution (IDR) process has racked up $22.4 billion in extra healthcare costs since 2022. But specialty physician groups are firing back, calling the estimate fundamentally flawed due to its reliance on an insurer-calculated benchmark they say is artificially low.
A new Georgetown University study published in Health Affairs estimates that the No Surprises Act's independent dispute resolution (IDR) process has generated $22.4 billion in extra U.S. healthcare spending since 2022 — with $15.6 billion attributed to provider payments exceeding in-network rates. Dispute volumes surged 77% in 2025 alone, and total IDR awards jumped 264% year-over-year, raising alarms that the law meant to protect patients from surprise bills may actually be inflating premiums.
Not so fast, say the doctors. The American Society of Anesthesiologists, the American College of Emergency Physicians, and the American College of Radiology jointly pushed back, arguing the Georgetown estimate is built on a "deeply flawed premise" — namely, that the qualifying payment amount (QPA), an insurer-calculated benchmark for in-network rates, is accurate. Providers contend QPAs are artificially suppressed, and a recent federal court ruling agreed, striking down the existing QPA methodology. Georgetown's authors, however, stress their $22B figure holds even when adjusting for a higher benchmark.
By the Numbers:
Why it matters: The IDR battle is more than a billing spat — it's shaping insurance premiums for millions of Americans. UnitedHealthcare has already cited IDR as driving commercial premiums up 2–6%, and employers broadly estimate a ~2% medical trend inflation. With Congress and the Trump administration under pressure to reform the NSA, how the QPA debate is resolved could have sweeping consequences for healthcare costs nationwide.