Elevance Health Study Raises Concerns Over No Surprises Act Payment Dispute Process for Planned Medical Procedures
A new study from the Elevance Health Public Policy Institute is drawing attention to an unexpected consequence of the No Surprises Act, suggesting that while the landmark legislation has largely succeeded in shielding patients from surprise medical bills, the law’s payment dispute process may be driving significantly higher healthcare costs for certain planned medical procedures.
The research examines thousands of payment disputes resolved through the federal Independent Dispute Resolution (IDR) process and concludes that arbitration awards for scheduled procedures frequently far exceed standard in-network commercial reimbursement rates as well as Medicare payment levels. According to the researchers, the findings raise questions about whether the dispute resolution system is operating in line with the original intent of the legislation.
No Surprises Act Achieves Patient Protection Goals
The No Surprises Act, which took effect in 2022, was enacted to protect consumers from unexpected medical bills that often occurred when patients unknowingly received care from out-of-network physicians at in-network hospitals or during emergency situations. Before the law’s implementation, patients frequently faced substantial financial liabilities after receiving treatment from providers who were outside their insurance network, despite choosing in-network healthcare facilities.
To eliminate these surprise bills, the legislation shifted payment disagreements away from patients and instead established a structured arbitration process between healthcare providers and insurance companies. Under this system, if insurers and providers cannot reach an agreement regarding reimbursement for services covered under the law, either party may submit the dispute to an independent arbitrator through the federal Independent Dispute Resolution process.
The primary objective was to protect patients from financial hardship while providing a fair mechanism for resolving payment disagreements between insurers and healthcare providers.
According to Elevance Health researchers, those patient protections have largely been successful. However, they argue that the payment dispute mechanism itself may now be producing unintended financial consequences, particularly for procedures that are planned well in advance rather than emergency medical services.
Research Focuses on Scheduled Medical Procedures
Rather than examining emergency room visits or unexpected hospital care, the Public Policy Institute focused its research on a category of healthcare services that patients typically schedule in advance.
The analysis reviewed more than 7,300 payment disputes involving medical procedures that included spine surgery, plastic surgery, colonoscopy services, and other elective or scheduled treatments. Although these procedures occurred at in-network healthcare facilities, they involved out-of-network providers, making them eligible for arbitration through the federal IDR system.
Researchers sought to understand whether arbitration outcomes for these planned procedures aligned with commercial market reimbursement levels or whether the dispute process was producing substantially different payment outcomes.
Their findings suggest significant disparities between arbitration awards and conventional reimbursement rates.
Providers Won Nearly Nine Out of Ten Disputes
One of the study’s most notable findings was the high success rate achieved by healthcare providers during arbitration.
According to the research, providers prevailed in approximately 89.5 percent of disputed claim lines included in the analysis. This indicates that arbitrators overwhelmingly ruled in favor of provider payment requests rather than insurer payment offers.
Researchers suggest that such a high provider success rate could influence reimbursement expectations and potentially encourage additional disputes over payment amounts.
The study also noted that the number of disputes entering the federal arbitration system has expanded well beyond the volumes originally anticipated when the No Surprises Act was enacted.
That growth has prompted renewed discussion among policymakers, employers, insurers, and healthcare organizations regarding whether modifications to the dispute resolution framework may be necessary to maintain affordability while preserving patient protections.
Arbitration Awards Far Exceeded Standard Payment Levels
Beyond provider success rates, the report highlights the magnitude of arbitration awards issued through the IDR process.
Researchers found that the average payment awarded through arbitration for the procedures analyzed approached $40,000.
By comparison, benchmark reimbursement rates based on commercial in-network contracts or Medicare payment schedules typically ranged between approximately $645 and $1,600 for comparable services.
Even more striking was the difference between median arbitration awards and negotiated commercial rates.
According to the study, the median payment awarded through IDR exceeded the median contracted in-network payment for the same service within the same geographic market by more than fifty times.
Researchers argue that these differences raise important questions regarding the incentives created by the current arbitration system.
If arbitration consistently produces reimbursement levels substantially higher than negotiated contracts, providers may have less motivation to participate in insurer networks, potentially contributing to rising healthcare costs throughout the broader healthcare system.
Payments Continue to Increase
The research also identified a rapid increase in arbitration awards over time.
Between 2024 and 2025, payments awarded through the IDR process for the procedures examined increased by approximately 43 percent.
This upward trend, according to researchers, suggests that reimbursement levels awarded through arbitration continue to escalate despite the No Surprises Act’s original objective of balancing provider compensation with consumer affordability.
The findings indicate that the financial impact of arbitration decisions may continue to expand if current trends persist.
Highest-Dollar Disputes Involved Scheduled Procedures
Researchers observed that many of the most expensive payment disputes involved procedures that patients generally plan weeks or months in advance.
Among these were certain spine surgeries and plastic surgery procedures, which generated some of the largest arbitration awards included in the study.
Unlike emergency medical treatment, these scheduled services often allow time for patients, providers, and insurers to coordinate care beforehand.
Because patients typically have greater opportunity to understand where care will be delivered and by whom, researchers suggest these cases differ substantially from the emergency situations that originally motivated the passage of the No Surprises Act.
The study argues that these distinctions warrant closer examination as policymakers consider future refinements to the legislation.
Elevance Health Calls for Policy Review
Catherine Gaffigan, MD, President of Health Solutions at Elevance Health, said the research demonstrates that while patient protections remain essential, the payment dispute process may be functioning in ways Congress did not originally intend.
According to Gaffigan, the No Surprises Act was created to shield patients from unexpected medical bills rather than contribute to higher healthcare spending.
She explained that the Public Policy Institute’s research raises concerns that arbitration is increasingly being used for certain scheduled procedures in ways that diverge from the law’s intended purpose.
Gaffigan emphasized that when the dispute resolution system is exploited, employers and families ultimately bear the financial burden through increased insurance premiums and higher overall healthcare expenses.
She added that maintaining strong patient protections requires ensuring that arbitration is used appropriately and continues to function as lawmakers originally envisioned.
Researchers Recommend Additional Safeguards
Aliza Gordon, Director of Research at the Elevance Health Public Policy Institute and co-author of the study, said the findings point toward the need for additional safeguards within the arbitration process.
According to Gordon, payments awarded through the federal arbitration system for planned procedures were generally far higher than compensation clinicians typically receive through negotiated in-network agreements for comparable services.
She noted that the substantial differences between arbitration awards and market reimbursement levels raise important policy questions regarding how the dispute resolution process currently operates.
Gordon suggested that policymakers should evaluate whether additional protections could help preserve affordability while maintaining fair payment practices.
Employers Express Growing Concerns
The study also received support from employer organizations concerned about rising healthcare costs.
James Gelfand, President and CEO of The ERISA Industry Committee (ERIC), said the findings reflect what many large employers have been observing as arbitration activity has expanded.
According to Gelfand, the Independent Dispute Resolution process has moved well beyond its original purpose.
He argued that arbitration awards reaching levels dozens of times higher than market reimbursement rates effectively create a mechanism that inflates healthcare costs rather than resolving payment disagreements fairly.
Gelfand stated that employers ultimately finance these increased payments through higher insurance premiums, increased healthcare spending, and reductions in employee benefits.
He emphasized that while Congress successfully established important patient protections through the No Surprises Act, policymakers should consider reforms that address the growing financial impact of arbitration awards without weakening protections against surprise medical billing.
Growing Federal IDR Caseload
The Elevance Health study comes amid continued growth in the number of disputes submitted to the federal Independent Dispute Resolution process.
When lawmakers developed the No Surprises Act, the arbitration system was intended to serve primarily as a limited backstop for resolving relatively uncommon payment disagreements.
Instead, dispute volumes have expanded far beyond initial expectations, increasing administrative complexity and raising broader questions about long-term sustainability.
Researchers argue that the combination of rising dispute volumes, high provider success rates, and increasingly large arbitration awards may create incentives that encourage additional reliance on the IDR process rather than negotiated contracting.
Such trends could place additional financial pressure on employers, health plans, and ultimately consumers.
Balancing Consumer Protection and Healthcare Affordability
Despite its concerns regarding arbitration outcomes, the Public Policy Institute emphasizes that the No Surprises Act has largely fulfilled its central mission of protecting patients from unexpected medical bills.
Researchers do not recommend eliminating these protections. Instead, they suggest that policymakers evaluate targeted reforms designed to ensure the dispute resolution process remains focused on the circumstances Congress originally intended to address.
Such reforms, they argue, could preserve strong consumer protections while limiting opportunities for payment inflation associated with certain planned procedures.
As debate over healthcare affordability continues, the study contributes new evidence regarding the evolving financial impact of the No Surprises Act’s arbitration framework. With federal dispute volumes continuing to rise and arbitration awards increasing, the report is likely to play a role in ongoing policy discussions about how best to balance patient protection, provider reimbursement, insurer participation, and long-term healthcare affordability.
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