Press Release

New Study: No Surprises Act IDR Process Cost Americans $22.4 Billion in Wasteful Spending

Issued by AHIP [America's Health Insurance Plans]

Aug. 27, 2026

A new study published in Health Affairs finds that the No Surprises Act’s independent dispute resolution (IDR) process has so far cost Americans an estimated $22.4 billion in wasteful spending.

The findings of the study by Georgetown University’s Center on Health Insurance Reforms are the latest in a growing body of evidence that Americans are paying for the persistent abuse of the IDR process by certain private equity-backed providers and IDR middlemen.

By The Numbers:

• $22.4 billion in total IDR costs: The IDR system resulted in $22.4 billion in total costs from 2022 to 2025, and the data estimates that IDR costs reached $16.6 billion in 2025 alone, nearly 3.5 times the amount in the previous year.
• 264% increase in award amounts: While dispute volume was up 77 percent from 2024 to 2025, total awards rose by 264 percent, more than triple the volume growth.
• $2.7 billion in fees to IDR entities: With the incentive to push as many disputes through IDR as possible, the fees taken by IDR entities continue to increase.
• Millions of disputes and counting: Providers initiated 1.75 million disputes in the first six months of 2026 alone, 50% more than the same period last year.
• 3/4 of cases, 3 organizations: In 2025, “over three-fourths of [cases] came from...three organizations” — two provider groups with private-equity backing and one middleman organization that files disputes on behalf of providers, whose abuse of the system has been covered at length by STAT.

Why It Matters: The study notes that employers and health plans are already reporting higher premiums as a result of provider-driven IDR abuse. New York’s state employee health plan reported more than $200 million in additional claim payments from IDR and cited those costs as a primary contributor to its nearly 10% premium increase in 2025.

What AHIP Is Saying:

"Outrageous provider-driven abuse of the No Surprises Act is adding billions in wasteful spending and raising healthcare costs for everyone. There is growing, bipartisan recognition that policy action is needed to put an end to this gold rush and protect consumers from unconscionable price gouging by some out-of-network providers and IDR middlemen," said Chris Bond, AHIP spokesperson.

Learn more about how health plans are working to protect consumers and bipartisan policy solutions to make healthcare more affordable at AHIP.org/CostConnection.

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