Arbitration awards under the No Surprises Act's federal independent dispute resolution (IDR) process generated an estimated $8.39 billion in additional health plan payment obligations for determinations closed in 2025 - roughly 63 cents for every $100 in employment-based health plan costs - according to new research from the Employee Benefit Research Institute (EBRI) published November 12, 2026.
The figure is the most direct measurement yet of what group health plans owe out-of-network providers beyond their initial payments, and it arrives as policymakers, brokers, and plan sponsors continue to debate the full financial impact of the No Surprises Act on employer-sponsored coverage.
The No Surprises Act, enacted in 2020, generally protects patients from unexpected out-of-network balance bills for covered services.
When payment disputes between health plans and out-of-network providers remain unresolved after negotiation, either party may submit the claim to the federal IDR process - a form of baseball arbitration in which both sides submit an offer and an independent arbitrator chooses one outright, with no splitting the difference.
Federal agencies initially projected the process would handle approximately 22,000 cases annually. The reality has been dramatically different: about 2.56 million disputes were initiated in 2025 alone, according to the Centers for Medicare & Medicaid Services (CMS) data from the first and second halves of the year.
The research was made possible by CMS adding initial payment amounts and patient cost-sharing data to its federal IDR public-use files beginning in the third quarter of 2025.
That addition allowed EBRI to calculate what it calls "IDR uplift" - the prevailing arbitration award minus the plan's initial payment minus patient cost-sharing - more directly than prior studies that relied on benchmark payment rates as proxies.
Paul Fronstin, Ph.D., director of Health Benefits Research at EBRI, walked through a plain-English example during a press briefing attended by Insurance Business Benefits US.
He said that if an arbitration award came to $1,000, the plan's initial payment was $200, and patient cost-sharing was $100, the additional plan payment obligation for that award would be $700. EBRI applied that calculation across every award in the CMS database where complete data were available.
Because initial payment and cost-sharing fields were only added by CMS from Q3 2025 onward, EBRI used different methodologies for the first and second halves of the year. The first-half figure of $3.66 billion was estimated using the qualified payment amount (QPA) – roughly the median amount that health plans pay for a given service. The second half, calculated directly from the new CMS data, produced a figure of $4.73 billion, bringing the full-year total to $8.39 billion.
"We know there's a trend towards more awards," he said, "which is one of the reasons why we're not estimating the impact on premiums, because the trend to more awards is going to drive that percentage up closer to 1% and perhaps eventually above 1%."
Sensitivity tests removing awards above $500,000 or $100,000 kept the aggregate figure above $8 billion throughout - the headline $8.39 billion figure emerged after EBRI excluded just 27 outlier awards, each exceeding $1 million or falling below negative $1 million. Those 27 records alone had accounted for close to $2 billion in reported spending, and their implied services made the figures implausible.
The estimate represents approximately 0.625 percent of the $1.34 trillion in national employment-based health plan costs, including premiums and equivalent costs for self-insured plans.
Fronstin offered a pointed frame of reference: with premiums rising at mid-to-high single-digit rates in 2025, the IDR uplift amounts to just under 10 percent of a hypothetical 10 percent premium increase.
He also compared the finding to a separate recent EBRI paper, examining site-neutral payment reform - a policy that would eliminate higher facility fees for infused medications delivered in physician offices. That analysis found roughly a one percent savings potential.
"It's often in line with some of the other things we've looked at when it comes to the impact of various things on premiums," Fronstin said. "It's small. I don't want to say it doesn't have any impact on premiums - it's a small impact."
"These new data provide a clearer picture of what health plans owe for out-of-network services beyond their initial payments, after accounting for patient cost sharing," Fronstin said. "The $8.39 billion estimate equals approximately 0.625% of employment-based health plan costs, but it does not establish how much the No Surprises Act changed premiums."
Three limitations are critical for benefits advisors and plan sponsors interpreting the number.
First, the analysis covers only disputes that entered the federal IDR process. Claims resolved outside arbitration - which represent the majority of No Surprises Act disputes - are not captured, meaning the figure does not reflect the law's total premium impact.
Second, the estimate assumes all awards are paid in full. CMS data do not verify whether or when providers actually received payment - and Fronstin noted some external data suggest a meaningful volume of awards go unpaid. If nonpayment is widespread, the true additional obligation to plans would be lower than $8.39 billion.
Third, EBRI flagged a potential behavioral incentive the study did not examine: the law may encourage some providers to deliberately go out of network specifically to pursue IDR and obtain higher payments.
According to CMS data, providers, facilities, or air ambulance services were the prevailing party in approximately 85 percent of payment determinations in the second half of 2025, down slightly from 88 percent in the first half. Each side submits a price justification and the arbitrator must choose one offer outright, with no ability to split the difference.
The full report, "The Federal Independent Dispute Resolution Process and Employment-Based Health Plan Costs," is available at www.ebri.org/no-surprises-act.
