For the past two renewal cycles, group benefits brokers have fielded the same uncomfortable question from clients: why did our health plan's costs jump again, when nothing about our workforce changed? A study published this week gives brokers a more precise answer than they've had before, and it points squarely at a corner of the No Surprises Act that most plan sponsors have never heard of.
Researchers at Georgetown University's Center on Health Insurance Reforms, housed in the McCourt School of Public Policy, found that the law's independent dispute resolution (IDR) process — the arbitration system that settles pay disagreements between insurers and out-of-network providers — has generated $22.4 billion in total costs since it launched, with the pace accelerating sharply through 2025. The findings were published Wednesday in Health Affairs.
Of that total, $15.6 billion came from payments to providers that exceeded what insurers would normally pay an in-network doctor for the same service. Another $4.2 billion went to administrative costs, and $2.7 billion covered fees charged by the independent arbitration firms that decide the cases. Jack Hoadley, a research professor at the center and one of the study's authors, told reporters the true figure is probably higher, since the federal data set doesn't capture everything insurers and providers spend internally managing disputes.
"We actually think our estimate is conservative," Hoadley said.
The IDR process was supposed to be a backstop, used only when insurers and providers couldn't agree on a fair price for an out-of-network claim on their own. Federal regulators originally projected about 17,000 standard disputes a year, plus roughly 5,000 more from air ambulance claims, for a combined estimate of about 22,000 disputes annually when the system was designed. Instead, the researchers found that 2.6 million disputes were filed in 2025 alone, up 77% from the year before. Early data for 2026 suggests the volume keeps climbing: roughly 1.75 million disputes were filed in the first six months of this year, 50% more than the same period in 2025.
Most of that volume isn't coming from individual physicians occasionally hitting an impasse with an insurer. The study found that three organizations account for nearly three-quarters of all resolved disputes: Radiology Partners, with about 30%; HaloMD, a billing and arbitration specialist that represents providers rather than treating patients itself, with roughly 27%; and TeamHealth, with about 20%. Radiology Partners and TeamHealth are both backed by private equity, and HaloMD's share of the market has grown sharply since 2024 as it's built a business model around filing claims into arbitration on providers' behalf.
That matters for brokers because providers are winning. The data show providers prevailed in 85% of disputes decided in 2025, peaking at 88% in the second quarter. And when they win, the awards have gotten considerably larger: total payouts through IDR grew 264% between 2024 and 2025, with a growing share of awards landing in the highest payment brackets.
The specialty-level detail is where the numbers get eye-catching. For emergency medicine claims, the median 2025 award equaled 315% of the qualifying payment amount (QPA), the benchmark rate insurers use as their opening offer. Median awards in neurology and plastic surgery roughly doubled year over year, landing between 24 and 30 times the QPA. The study singled out breast reduction procedures as an example: median arbitration awards for the procedure ran more than 80 times what Medicare pays for the same service, adding up to $62.7 million in payments industry-wide.
Brokers advising self-funded plan sponsors have another reason to pay attention this month: the fight over who gets to challenge these awards is now playing out in federal appeals court. In April, a magistrate judge in the U.S. District Court for the Central District of California dismissed a lawsuit that Elevance Health's Anthem Blue Cross subsidiary had filed against HaloMD, ruling that federal courts generally lack authority to second-guess IDR award decisions once they're issued. Anthem had accused HaloMD of gaming the arbitration system to inflate provider payouts.
Three employer coalitions — the American Benefits Council, the ERISA Industry Committee and the Business Group on Health — are now asking the Ninth Circuit Court of Appeals to overturn that ruling, arguing in a brief filed last week that shutting the courthouse door leaves plan sponsors with no recourse against what they call bad-faith arbitration conduct. That case could still see further appeals in California, and it's unfolding alongside a separate fight over the benchmark rate behind every award. Depending on how the two are resolved, brokers could end up dealing with both a changed appeals process and a changed pricing formula in the same year.
That pricing formula is the one to watch most closely. In August, the full Fifth Circuit Court of Appeals ruled that the government's method for calculating the QPA benchmark was unlawful, siding with the Texas Medical Association and other provider groups. If that ruling stands, it could push QPA benchmarks, and therefore arbitration outcomes, even higher, adding yet another layer of cost pressure for group plans heading into 2027 renewals.
None of this is abstract for brokers. Hoadley was direct about where the money ultimately lands: rising IDR costs will inevitably flow through to what consumers pay, he said, and some employers and insurers are already pointing to arbitration expenses when they explain this year's premium increases. He argued lawmakers may need to revisit the law's design so it can still "realize the law's original cost containment goals" without weakening the patient protections that built support for the statute in the first place.
For brokers sitting across from self-funded employers this renewal season, the practical takeaway is straightforward: IDR exposure is no longer a niche compliance issue buried in stop-loss conversations. It's a measurable, fast-growing line item that carriers are already citing when they explain premium increases. Clients are going to ask what it is and why it's rising — and now there's a number to point to.
