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The No Surprises Act was meant to protect patients from unexpected medical bills, but its arbitration process is quietly draining employer health plans. A new EBRI study found the independent dispute resolution (IDR) process cost employer plans $8.39 billion in 2025 alone — and total IDR-related costs hit $22.4 billion that year, nearly 3.5 times higher than in 2024.
The No Surprises Act (NSA) was designed to shield patients from surprise out-of-network bills, but its dispute resolution mechanism is generating a financial headache of its own. A new analysis from the Employee Benefit Research Institute (EBRI) found that the NSA's independent dispute resolution (IDR) process cost employer-sponsored health plans $8.39 billion in 2025 — roughly 63 cents per $100 spent by employer-based insurance. That figure held firm even after analysts excluded outlier awards, landing at a floor of $8.02 billion.
Zooming out, a Georgetown University study pegged total IDR-related costs at $22.4 billion in 2025 — nearly 3.5 times higher than in 2024. Providers won 85% of IDR disputes, often securing payouts far above in-network rates. A small number of organizations — Radiology Partners, HaloMD, and TeamHealth — accounted for nearly three-quarters of resolved disputes, with two of the three backed by private equity. Employers report the costs are unpredictable and nearly impossible to audit or control.
By the Numbers:
Why it matters: What started as a consumer protection law is increasingly looking like a cost driver. With IDR awards already nudging up insurance premiums and employer health budgets, lawmakers face growing pressure to reform the system before costs spiral further out of control.