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No Surprises Act default arbitration outcomes may cost self-funded plans
A white paper cited by Insurance Business says more than one in five arbitration rulings in the first half of 2025 were decided by default, with plan sponsors rarely seeing why.
Self-funded employers are losing an increasing share of federal No Surprises Act arbitration cases where the plan side does not make its case, according to a white paper released September 17, 2026 and discussed by Insurance Business. The paper says more than one in five arbitration rulings in the first half of 2025 were settled by default, and that providers gained the most ground in those outcomes.
The dispute process involves the federal independent dispute resolution (IDR) system, after a plan and an out-of-network provider fail to agree on payment during a 30-business-day open negotiation period. In IDR, a certified arbitrator selects one of two final offers, and if a party does not submit the evidence needed to contest the case, the other side wins by default, with the award still paid from plan assets.
Insurance Business notes that in self-funded plans, a third-party administrator or administrative-services-only carrier typically handles the dispute and selects the offer submitted for the plan. The outlet also points to a KFF 2025 Employer Health Benefits Survey, cited in the paper, showing 67 percent of covered workers are in self-funded plans, rising to 80 percent at firms with 200 or more workers.
The article further states that Insurance Business cites a March 2026 Health Affairs Forefront analysis, which it uses alongside the ERISA Industry Committee paper to highlight how often plan sponsors do not receive clear reasoning when cases are decided by default.