TL;DR
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Congress is weighing competing proposals to address problems in the No Surprises Act’s payment-dispute process. One bill would replace arbitration with a benchmark based on the qualifying payment amount; another would penalize insurers that do not pay arbitration awards on time. The dispute system’s costs, enforcement rules and potential legislative path remain unsettled.
Congress is considering competing proposals to change the No Surprises Act’s payment-dispute system, after arbitration cases rose far beyond the government’s initial estimate and providers and insurers continued to fight over awards. The options include a bill to replace arbitration with a payment benchmark and another that would penalize insurers for late payments, but lawmakers have not settled on a fix.
The law, enacted at the end of 2020, protects patients from many unexpected out-of-network bills for care received at an in-network facility. When an insurer and an out-of-network provider cannot agree on payment, they can use independent dispute resolution (IDR), a form of arbitration. The dispute is between the insurer and provider; the patient protection is the law’s central purpose.
Georgetown health policy expert Jack Hoadley told MedPage Today that arbitration has become a larger part of the system than lawmakers anticipated. The government estimated about 22,000 disputes a year would enter IDR, while Hoadley said there were more than 4 million disputes in 2025. He also said arbitrators sided with providers in about 85% of cases, a pattern he argued can encourage higher payment requests. Those figures describe the source’s account; the report does not provide a detailed breakdown of the disputes or their outcomes.
Rep. Frank Pallone, the top Democrat on the House Energy and Commerce Committee, introduced a bill on October 8 that would eliminate IDR and use the qualifying payment amount, or QPA, as the payment basis. A separate proposal from Rep. Greg Murphy, first introduced in September 2024, would impose steep penalties on insurers that fail to pay arbitration awards within 30 days and require more reporting on payment compliance.
The Stakes for Patients and Providers
The dispute process affects how much insurers pay out-of-network providers when the two sides cannot settle, and that can shape the financial terms of care delivered at in-network facilities. Patients are protected from many surprise bills under the law, but disagreements over provider payments can still affect insurers, medical practices and the operation of the system.
Changing IDR could shift leverage between insurers and providers. The American Society of Anesthesiologists, American College of Radiology and American College of Emergency Physicians oppose eliminating arbitration, arguing that insurers should not gain greater control over physician payments. Consumer group Families USA supports Pallone’s proposal, saying a benchmark could remove incentives to flood arbitration with disputes and seek inflated payouts. These are advocacy groups’ positions, not findings established by the report.
Unpaid awards add a separate enforcement concern. If providers cannot readily collect decisions in their favor, the dispute process may not resolve payment conflicts in practice. The competing bills therefore address different problems: one would change how payments are determined, while the other would focus on timely payment and reporting.
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How IDR Became a Flashpoint
The No Surprises Act created the QPA, intended to approximate the median rate paid for comparable in-network care. Hoadley said regulators initially proposed treating that figure as the default in arbitration, but federal courts rejected that presumption and required arbitrators to consider other factors. The report does not detail each ruling or the current rules governing every case.
According to Hoadley, provider wins in many arbitrations and high awards have accompanied a large rise in filings. Attorney Josh Hill told MedPage Today that insurers have also stopped paying some awards. He said the statute requires payment within 30 days but does not clearly provide a way to enforce an award through a lawsuit. The source reports that two appeals courts found providers could not sue to collect awards, while a lower court reached the opposite conclusion.
These disputes put Congressional action alongside ongoing litigation. Hoadley told the publication that the problems are unlikely to be resolved through administrative action alone and that a solution probably rests with Congress.
“The dispute resolution system “is currently broken.””
— Jack Hoadley, professor emeritus at Georgetown University’s Center on Health Insurance Reforms
Unresolved Rules and Legislative Choices
It is not clear which, if any, of the proposals can advance, or whether lawmakers will pursue a different compromise. The report does not provide a legislative timetable, a committee schedule or details on the proposals’ prospects for support across both parties. Physician groups and consumer advocates are taking opposing positions on whether IDR should remain.
The court dispute over enforcement also remains active. Hill said cases are pending in Maryland and Virginia and could reach another appeals court. If appellate courts disagree, he said, the Supreme Court could take up the issue; that outcome is a possibility, not a confirmed next step. The source does not identify the cases’ expected decision dates or establish how many awards remain unpaid.
Congress and Courts Set the Course
Congress may consider the competing approaches as lawmakers weigh whether to retain arbitration, change the payment benchmark or strengthen penalties for late payments. No vote or next legislative milestone is specified in the report. The proposals’ progress and any negotiations among lawmakers and affected groups will indicate whether Congress is moving toward a broader rewrite or a narrower enforcement change.
Meanwhile, pending cases may clarify whether providers can sue to collect unpaid IDR awards. Congressional action and court rulings could both affect how the system operates, but the timing and outcome of either remain uncertain. For now, the patient protections remain in place while payment disputes and the search for a legislative fix continue.
Key Questions
What is Congress considering changing?
Lawmakers are weighing proposals affecting the independent dispute resolution process under the No Surprises Act. One would replace arbitration with the qualifying payment amount as the payment basis; another would penalize insurers for not paying awards within 30 days.
Would the Pallone bill eliminate the No Surprises Act?
No. As described in the report, Rep. Frank Pallone’s bill would eliminate the arbitration system and use the QPA to determine payment. The report does not say that the broader patient protections against surprise out-of-network bills would be repealed.
How many disputes entered arbitration in 2025?
Jack Hoadley told MedPage Today that more than 4 million disputes entered the process in 2025. The government had estimated about 22,000 disputes per year. These are figures reported in the source; it does not provide additional detail on case types or outcomes.
Can providers sue insurers over unpaid arbitration awards?
The issue is contested in court. Hill said two appeals courts found providers could not sue to collect awards, while a lower court ruled differently. Cases remain pending, and the report does not say when they will be decided.
Source: medpagetoday.com
