The number of out-of-network billing disputes proceeding to arbitration continues to grow, much to the consternation of health plans.
New data from the Centers for Medicare & Medicaid Services show that nearly 1.4 million disputes were initiated in the back half of 2025. By comparison, close to 1.2 million disputes were initiated in the first six months of 2025.
Insurers have roundly criticized the independent dispute resolution (IDR) process as cases—and payments to providers—balloon. The Wall Street Journal got an early look at the tranche of data, and found that providers earned close to $15 billion in IDR payouts across 2025, a sharp increase from the nearly $4.1 billion in payments made in 2024.
The new CMS reports also highlight that payments determined through the IDR process tend to be higher than the proposed qualifying payment amount (QPA) put forward by insurers during negotiations, and that large swaths of the disputes come from a small number of organizations.
For example, in the fourth quarter of 2025, payment determinations were made in 532,548 disputes. In 462,973 of those cases, the payment established through IDR was higher than the proposed QPA, per the CMS data.
In addition, in both Q3 and Q4 of last year, 42% of disputes were challenged as ineligible, according to the reports.
HaloMD topped the list in both quarters, accounting for 19% of disputes initiated each quarter. TeamHealth was second, initiating 11% of disputes in both Q3 and Q4.
SCP Health was third-highest in both quarters, initiating 10% of disputes in the third quarter and 7% in the fourth quarter. Rounding out the top five was F&A Management with the fourth-highest number across both quarters and Radiology Partners with the fifth-highest.
Payers have challenged these companies in the courts, but have been on a losing streak. Just last week, a Georgia court tossed a case brought against HaloMD by one of Elevance Health's Anthem plans.
Insurers have also called on regulators to take action.
"Outrageous provider-driven abuse of the No Surprises Act is adding billions in wasteful spending and raising healthcare costs for everyone," AHIP Spokesperson Chris Bond said Wednesday in a statement on the CMS reports. "Policy action is needed to address flawed incentives in the IDR process, put an end to this gold rush and protect consumers from unconscionable price gouging by some out-of-network providers and IDR middlemen."
Providers have countered that they are often forced to escalate a dispute to IDR as payers undercut them in negotiations.
In late May, CMS finalized a rule that aims to reform the IDR process, introducing batch determinations and an online portal for providers to track the status of disputes. And while the rule was well-received by provider groups, payers said it didn't do much to stem the tide of IDR "flooding" behavior.