The No Surprises Act was designed to solve a real problem, patients receiving medical care, often in emergencies, only to discover afterward that a provider was out of their health insurance network and left them with an enormous bill.

While health plans generally treat emergency care at an out-of-network hospital like in-network care, the law also protects you if you go to an in-network hospital but receive care from an out-of-network provider you didn’t choose, such as an anesthesiologist or radiologist.

On that front, the law has worked. Since taking effect in 2022, it’s protected patients from an estimated 50 million surprise medical bills. But a growing body of evidence suggests the law may have solved one affordability problem while inadvertently creating another.

How did this happen?

The law protects patients from being caught in the middle of many out-of-network disputes, but the provider still must be paid. When a health plan and an out-of-network provider can’t agree on how much that payment should be, either party can take the dispute to the federal Independent Dispute Resolution process. Each side proposes a payment amount, and an independent arbitrator must choose one of the two offers.

The process was intended to settle payment disputes. Instead, its use has exploded. More than 9 million disputes have been initiated since 2022, exceeding initial federal projections tenfold.

Georgetown University researchers analyzing federal data found doctors and hospitals prevailed in about 85% of disputes in 2025. The average payment award was 350% – 400% higher than what health plans typically pay for the same service, according to Centers for Medicare & Medicaid Services (CMS) data.

In a  striking example reported by The New York Times, an assistant surgeon received more than $50,000 through the dispute resolution process for a prostate procedure, while the in-network surgeon performing the operation was paid $1,843. The disparity illustrates how dramatically awards can differ from negotiated in-network payments.

Those differences add up. Georgetown researchers estimate the process resulted in more than $22 billion in excess payments to providers and administrative costs over four years.

Patients still pay the price

The No Surprises Act protects individual patients from receiving unexpected out-of-network bills. But when the overall system produces payments billions of dollars higher than typical in-network rates, those costs do not simply disappear.

Employers and consumer advocates warn that these higher payments increase health plan spending, putting upward pressure on premiums for everyone. High arbitration awards may discourage providers from joining insurance networks, leaving patients with fewer in-network choices and contributing to higher healthcare costs.

That is why nearly 70 organizations representing patients, consumers, employers and workers recently urged Congress to reform the system. As the coalition put it, the law’s promise of protecting patients while lowering costs “has been broken.”

The organizations say the answer is not to abandon the No Surprises Act. It is to fix the part that is not working as intended.

Do you think Congress should fix the system that determines what these bills ultimately cost? We want to hear from you, share your perspective. 

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