TL;DR
Get health and wellness essentials delivered free with Prime
- Fast, free delivery on millions of items
- Prime Video, Amazon Music and more included
- Member-only deals all year
Congress is weighing competing proposals to address problems in the No Surprises Act’s payment dispute system. One bill would replace arbitration with a payment benchmark; another would penalize insurers that fail to pay arbitration awards on time. No solution has been enacted, and providers, insurers and consumer advocates disagree on the best approach.
Congress is considering competing changes to the No Surprises Act, as the law’s independent dispute resolution system faces far more cases than projected and providers say some arbitration awards go unpaid. The proposals differ sharply: one would eliminate arbitration in favor of a payment benchmark, while another would penalize insurers that miss the deadline to pay awards.
The No Surprises Act, passed in late 2020, protects patients from many unexpected out-of-network bills, including bills for emergency care at an in-network facility. When insurers and out-of-network providers cannot agree on payment, they can turn to independent dispute resolution (IDR), in which an arbitrator selects a payment offer.
Georgetown University health policy analyst Jack Hoadley told MedPage Today that lawmakers expected IDR to be used in a relatively small number of cases, after negotiations failed. The federal government estimated 22,000 disputes a year would enter the process; Hoadley said there were more than 4 million disputes in 2025. Those are reported case totals, not a measure of how many awards were paid or how much they cost.
The latest proposal described in the report was introduced October 8 by Rep. Frank Pallone (D-N.J.), the top Democrat on the House Energy and Commerce Committee. It would replace arbitration with the qualifying payment amount (QPA), a benchmark intended to approximate the median in-network rate. A separate bill from Rep. Greg Murphy (R-N.C.), first introduced in September 2024, would impose steep penalties when insurers fail to pay awards within 30 days and require additional reporting on payment compliance.
Patients Are Protected, Payment Rules Are Not
The dispute is about how much insurers pay providers after a patient has received protected care—not whether patients should be exposed to surprise bills. Patients generally are not responsible for resolving these insurer-provider payment disagreements under the law. But the process can affect provider reimbursement, insurer costs and the operation of the federal dispute system.
Congress faces a choice between relying more heavily on a standardized benchmark and retaining case-by-case arbitration while tightening its rules. Providers argue that removing arbitration could give insurers too much control over payment; consumer advocates say arbitration has created incentives for excessive claims and inflated awards. Any change could alter how providers and insurers negotiate out-of-network payments, though the report does not establish what effects a particular proposal would have on premiums or care access.
Products Worth Considering
Withings Body Smart Wi-Fi and Bluetooth Smart Scale
Withings Sleep Under-Mattress Sleep Tracking Pad
Garmin Forerunner 165 GPS Running Smartwatch, 43 mm, Black
As an affiliate, we earn on qualifying purchases.
How the IDR Dispute System Developed
The law’s QPA was intended to reflect the median rate for comparable in-network care. Hoadley said the initial federal rule proposed treating it as the default presumption, with arbitrators able to depart from it for compelling reasons. Federal courts rejected that presumption, he told MedPage Today, requiring arbitrators to consider other factors as well. The account does not provide the specific court decisions or their dates.
Hoadley said providers prevailed in about 85% of arbitration cases, a result he linked to larger payment requests and the growth in filings. That figure is his account of case outcomes; it does not by itself establish why providers won or what each award was worth. Separately, attorney Josh Hill said the statute requires awards to be paid within 30 days but does not clearly provide a way for providers to sue to collect them. Courts have disagreed over whether providers can bring such suits.
“Most people did expect arbitration to be used modestly in a relatively low number of cases.”
— Jack Hoadley, professor emeritus at Georgetown University’s Center on Health Insurance Reforms
Courts and Congress Leave Key Questions Open
Neither proposal has been enacted, and the report does not say when Congress might act or whether either bill has enough support to advance. The competing positions also leave unresolved whether lawmakers will favor the QPA, retain arbitration with new safeguards, or combine elements of different proposals.
The legal question over whether providers can sue to collect unpaid awards remains unsettled. Hill said two federal appeals courts have ruled that providers have no right to sue, while a lower court reached the opposite conclusion. Cases are pending in Maryland and Virginia and could lead to further appeals. The report does not identify the cases’ schedules or predict when a court might rule.
The reported growth in filings and provider success rates point to pressure on the system, but the available account does not break down disputes by provider type, award size, insurer, or final payment status. It is also unclear how either proposal would affect payment amounts, premiums, or patient access if adopted.
Legislation and Pending Cases Ahead
Congress must decide whether to advance Pallone’s QPA-based approach, Murphy’s penalties and reporting requirements, or another set of changes. Hoadley told MedPage Today that a lasting solution is unlikely to come solely from administrative action and probably requires Congress, though the right legislative fix is not clear.
Meanwhile, the pending cases in Maryland and Virginia could clarify whether providers can take insurers to court to recover unpaid awards. If further appeals produce conflicting rulings, Hill said the Supreme Court could step in. For now, the law’s patient billing protections remain in place while the payment dispute rules and enforcement options remain contested.
Key Questions
What is Congress considering changing?
Lawmakers are considering proposals to change how insurers and out-of-network providers settle payment disputes under the No Surprises Act. One would replace arbitration with the QPA benchmark; another would impose penalties for late payment of arbitration awards and require more reporting.
Would the proposals end the law’s patient protections?
The report describes proposals about payments between insurers and providers, not a repeal of the law’s protections against many surprise out-of-network bills. Neither proposal has been enacted.
What is the QPA?
The qualifying payment amount is a benchmark intended to approximate the median rate for comparable in-network care. Pallone’s proposal would use it in place of the current arbitration system, according to the report.
Why are providers challenging unpaid awards?
The statute requires awards to be paid within 30 days, according to attorney Josh Hill. Courts have disagreed over whether providers can sue to collect awards that insurers do not pay.
Has Congress settled on a solution?
No. The report describes competing proposals and pending court cases, but gives no timetable for congressional action or a final resolution.
Source: rss
