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No Surprises Act IDR costs reach $22.4 billion, study finds
Georgetown researchers estimate 2.6 million disputes were filed in 2025, with the system’s pace accelerating through 2025 and 2026.
Insurance Business reports a Georgetown University study says the No Surprises Act’s independent dispute resolution, or IDR, process has produced $22.4 billion in total costs since it launched, with acceleration through 2025. The analysis, published in Health Affairs, attributes $15.6 billion of that total to provider payments above typical in-network amounts for the same services.
The study also breaks out an additional $4.2 billion for administrative costs and $2.7 billion for fees charged by independent arbitration firms that decide cases. Researchers said the true overall figure could be higher because federal data may not capture all insurer and provider spending related to disputes.
Insurance Business notes that regulators initially projected roughly 17,000 standard disputes per year, plus about 5,000 air ambulance disputes, for around 22,000 annually. Instead, the researchers found that 2.6 million disputes were filed in 2025, up 77% from the prior year, and early 2026 data suggests roughly 1.75 million filings in the first six months, 50% more than in the same period of 2025.
The study found that most resolved IDR disputes involve a small set of organizations, with Radiology Partners at about 30%, HaloMD at about 27%, and TeamHealth at about 20%. Insurance Business says employers and brokers have been pressing for explanations as group plan costs increase despite no change in the workforce.