In a recent letter, a group of 48 employer and consumer organizations call on the Trump administration to strengthen oversight of certified independent dispute resolution (IDR) entities, which resolve disputes under the No Surprises Act.
The letter was submitted last week to the Departments of Treasury, Health, Human Services and Labor. Signatories include the American Benefits Council, Families USA, the National Alliance of Healthcare Buyer Coalitions, the Purchaser Business Group on Health, and the ERISA Industry Committee.
The No Surprises Act protects patients from unexpected bills and eliminates payment friction between insurer and provider. The law requires insurers and providers to enter into 30 days of open negotiations to determine the amount paid to providers. If they cannot reach an agreement, each party can use the independent dispute resolution process, in which a provider submits a payment offer and an insurer submits a payment offer, and then a neutral arbitrator (called an IDR entity) chooses one.
However, many in the industry say the IDR process is now to be mistreated by some suppliers. The process was intended to be a “safety net of last resort” to resolve disputes between health plans and out-of-network providers, initially planned for 17,000 arbitration cases per year, according to the letter. But in the first half of 2025 alone, there have been more than 1.2 million cases.
“This is not organic dispute resolution,” the organizations said. “This is a large-scale, coordinated strategy systematically exploited by a small number of bad actors at the direct expense of American employers, workers and families. »
The letter adds that providers win about 88% of IDR cases with payments that are 300% to 900% of the median in-network amount. These costs are then passed on to consumers through higher premiums, deductibles and out-of-pocket costs.
The organizations also claimed that the IDR system was being “weaponized” by private equity firms. In the first half of 2025, 55% of disputes were initiated by just four companies: Team Health, Radiology Partners, SCP Health and HaloMD. The first three are backed by private equity.
“These are largely the same companies that spent years deliberately staying out of network to exploit patients, then pivoted to IDR when the No Surprises Act ended direct patient billing,” the letter states. “Now they are operationalizing arbitrage on an industrial scale. »
Additionally, the groups argued that the IDR process may contain structural conflicts of interest to the extent that arbitrators are paid for each case decided, providing incentives to prioritize volume over impartiality. The letter also cites concerns that some private equity firms invest in both healthcare providers filing arbitration claims and the IDR entities that adjudicate those disputes, raising questions about the independence of the arbitration system.
The organizations made several recommendations to the Trump administration to improve the IDR process, including:
- Investigate the independence of certified IDR entities
- Decertification of IDR entities that have conflicts of interest
- Require IDR entities to disclose ownership structures, compensation arrangements, and earnings data
- Create an initial eligibility check to prevent ineligible claims from going through the IDR portal
“The No Surprises Act promised American patients protection against abusive billing,” the groups said. “This promise is broken, not by the law, but by those who exploit its implementation for profit. The administration has both the power and the obligation to act.”
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