Industry giant UnitedHealthcare is adding its voice to the chorus of insurers criticizing the current state of the No Surprises Act's independent dispute resolution process.
During the company's earnings call on Thursday morning, company executives pointed to IDR as a drag on its commercial business. Dan Kueter, CEO of UnitedHealthcare Employer and Individual, said during the call that the "ineffective" process is "being exploited by select providers and select geographies."
This, he said, is contributing to the overall cost trend in the commercial market.
"It has existed for some time, it continues to accelerate in the volume of disputes, and that has highlighted the deficiencies of the IDR process," Kueter said.
He noted data that show about 40% of claims submitted to IDR are ineligible for the process, and that about 60% of arbitration cases stem from one of five organizations.
He added that another factor is that payouts from IDR when providers win also continue to escalate, with the average determination landing at about 11 times Medicare rates. Some resolutions can reach payments that are 30 times higher than Medicare rates, he said.
While there are some variations geographically as there are states with dispute processes that supersede the No Surprises Act's system, these trends generally hold across the country in regards to the federal IDR process, Kueter said.
"Hopefully that's clear evidence," he said, "it is certainly to employers of all sizes that the IDR process is not working, certainly not as Congress intended it, and it needs to be reformed."
Kueter's comments echo those from other insurers as well as from the industry's leading lobbying groups, which have all railed against the IDR process. When the No Surprises Act's resolution process was finalized, the Centers for Medicare & Medicaid Services anticipated that most disputes would be managed in the negotiation phase, without progressing to arbitration.
In practice, that hasn't been the case. In data (PDF) released in September 2025, the agency said the federal IDR portal received 14 times more submissions than was expected at its 2022 launch, and now the annual volume is 100 times higher than CMS' projections.
Last month, the Congressional Budget Office called for additional research into the No Surprises Act's dispute resolution process, warning that it could encourage providers to remain out-of-network as they have significant leverage in IDR.
AHIP, the main industry group for payers, said in a statement earlier this week that lawmakers should take a second look.
"Common-sense policy solutions are needed to restore the intent of Congress and the President in enacting the No Surprises Act: protecting consumers from surprise medical bills and lowering overall healthcare costs by reining in provider-driven abuse," AHIP said.
Payers have sought to challenge the entities driving much of the IDR "flooding" behavior in court, but have seen little success so far.
Meanwhile, providers charge that they are forced to escalate to IDR as payers frequently lowball them during negotiation.