Employer and consumer organizations are urging lawmakers to address "loopholes" in the No Surprises Act.
In a letter (PDF) submitted to House and Senate leaders on both sides of the aisle, nearly 70 groups representing employers, patients and labor unions argue that while the law has successfully averted millions of surprise medical bills, flaws in its processes are driving up healthcare costs.
They particularly point to the independent dispute resolution, or IDR, process, which has seen a growing contingent of critics. IDR is a baseball-style arbitration that is designed as a second level for resolving a claim if a payer and provider cannot come to an agreement in negotiation.
The number of cases proceeding to IDR over the past several years has far exceeded federal projections, the signatories note, and payouts to providers are escalating in tandem. In addition, there is a trend toward so-called IDR "flooding" from a small group of provider organizations and emerging IDR middlemen that is driving much of this trend.
A recent analysis from researchers at Georgetown University estimates that costs linked to the IDR process topped $22 billion in 2025, and that number could be even higher for this year.
Given their win rate and the high payouts, the organizations that account for large shares of IDR cases—many of which are backed by private equity—have little reason to give up the behavior, the letter argues.
"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," the groups wrote.
As these costs rise, insurers and plan sponsors will need to find outlets to manage them. And while patients cannot be billed directly for these surprise out-of-network services, they may see higher premiums as their plan seeks ways to defray the expenses.
The letter urges lawmakers to replace the current baseball-style approach with a predictable and transparent benchmarking model that would offer more clarity and certainty to all stakeholders, including patients, payers and providers. They also suggest that lawmakers establish a fair, market-based payment methodology to stymie gaming and prevent excessive reimbursement.
"In protecting millions of consumers each year from devastating surprise medical bills, the No Surprises Act is one of the most significant bipartisan consumer protection reforms in recent memory," the groups wrote. "But its central promise of protecting patients while lowering costs has been broken."