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Getting the latest healthcare news for you
A Health Affairs analysis claims the No Surprises Act's arbitration process cost $22.4 billion — but critics say the math is one-sided. The study counts arbitration costs while ignoring the law's savings, including reduced out-of-network payments for the 76% of claims that never even reach arbitration. Honest accounting, the authors argue, requires looking at both sides of the ledger.
A recent Health Affairs analysis made waves by claiming the No Surprises Act's (NSA) independent dispute resolution (IDR) arbitration process has racked up $22.4 billion in costs. But two health policy experts from Radiology Partners — the largest filer of NSA arbitration disputes — say the number is deeply misleading because it only counts costs, not savings.
The NSA was designed to protect patients from surprise out-of-network bills, and its arbitration process keeps patients out of payment disputes between insurers and providers. The Congressional Budget Office had projected the law would reduce spending — largely through lower in-network rates — but those savings are entirely absent from the Health Affairs analysis.
The authors also flag a structural flaw: 76% of NSA-eligible claims are accepted at the initial payment level and never reach arbitration, yet the study counts zero savings from those cases. Meanwhile, the $15.6 billion labeled as "payment amounts" reflects arbitration awards, not actual dollars paid — and physician surveys show many awards go unpaid or are paid late.
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Why it matters: Flawed cost analyses can drive flawed policy. If policymakers act on incomplete accounting, they risk harming providers — and ultimately patients' access to care — while leaving the real drivers of arbitration volume untouched.
