A leading Democrat in the House is probing the behavior of No Surprises Act arbiters.
Energy and Commerce Committee Ranking Member Frank Pallone, D-New York, sent letters to six certified independent dispute resolution (IDR) entities, seeking details on how each of them is conducting arbitration and staying in compliance with the law as IDR payouts rise.
Pallone's office sent letters to C2C Innovative Solutions, Inc.; Commence; Dane Street, LLC; EdiPhy Advisors, LLC; National Medical Reviews, Inc.; and ProPeer Resources, LLC on Thursday, per an announcement.
In the letters, he notes the rising number of surprise medical bills that are reaching IDR, rather than being resolved in negotiations, and escalating payments for services resolved through arbitration. A study released in August by researchers at the Georgetown University Center on Health Insurance Reforms estimated that costs related to IDR reached $22.4 billion at the end of 2025.
The study, which was based on federal data on the NSA, also found that there 2.6 million disputes initiated in 2025, a 77% increase from 2024.
Pallone said in the letters that he is concerned about reports that a number claims reaching IDR are ineligible, and the impact that higher payouts could have on consumers down the line. The New Jersey Democrat noted that he was a key voice in the passage of the No Surprises Act.
"For too long, patients were caught in the middle of billing disputes between providers and health plans," Pallone wrote. "While the law has protected millions of families from surprise medical bills, I am concerned that the independent dispute resolution process is not functioning as Congress intended and is resulting in increased out-of-pocket costs and higher premiums for consumers."
He is asking the IDR entities to disclose information and provide documents on a number of key points by Sept. 24, including hard data on dispute volume, eligibility determinations and default judgements made over the past several years.
In addition, Pallone wants the entities to offer additional detail on the compensation, training and credentials for the staff members who make determinations around eligibility and payment amount, as well as the role AI is playing, if any, in these decisions.
He's also seeking further information on the 10 organizations that are initiating the most disputes with each IDR entity. Research, including the Georgetown study, suggests that large volumes of IDR disputes are initiated by a small number of organizations, which are largely backed by private equity.