No Surprises Act Arbitration Payouts Near $15 Billion, Reports Find
A growing body of investigative reporting suggests the arbitration mechanism built into the 2020 No Surprises Act has become a cost-shifting tool that may be raising insurance premiums, raising...
The No Surprises Act, signed into law by President Donald Trump in December 2020 as part of the Consolidated Appropriations Act of 2021 (Public Law 116-260), was designed to shield patients from unexpected out-of-network medical bills. Recent investigative reporting by the Washington Examiner and others, published in August 2026, estimates that arbitration awards under the law's Independent Dispute Resolution (IDR) process have accumulated to nearly $15 billion, a figure that, if accurate, would represent a substantial transfer of costs that the law's authors did not anticipate at that scale.
The IDR process was established under the Act to resolve payment disputes between insurers and out-of-network providers when they cannot agree on a reimbursement rate. Under the statute, a certified arbiter selects either the insurer's offer or the provider's offer. Critics cited in recent media investigations argue that providers have systematically submitted higher offers and prevailed at rates that inflate payouts beyond what in-network contracts would have produced, with the difference ultimately passed to consumers through higher premiums.
The Centers for Medicare and Medicaid Services (CMS) and the Departments of Labor and Treasury jointly administer the IDR process and publish dispute resolution data. CMS released interim data in 2024 showing that providers won a majority of IDR decisions in the first full years of implementation, though the precise dollar total of awards across all payers has not been officially consolidated into a single public figure. The $15 billion estimate cited by media reports has not been independently verified by a government audit as of the publication date of this article.
No legislation to amend the IDR process has passed either chamber of Congress as of August 24, 2026. The House Energy and Commerce Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee both have oversight jurisdiction over the No Surprises Act. Congressional records show no committee markup of a corrective bill has been scheduled as of this writing.
What remains unknown is the precise, audited cumulative dollar value of all IDR awards since the Act took effect on January 1, 2022. A Government Accountability Office (GAO) review or an official CMS consolidated report on total arbitration payouts would be the public records most likely to confirm or revise the $15 billion figure cited in media coverage. It is also unknown whether either committee chairperson has formally requested such a report.