CBO Calls for Urgent Research as No Surprises Act Dispute Data Signals Rising Healthcare Costs

The Congressional Budget Office (搜索)搜索该词条 is raising alarms that the No Surprises Act—landmark legislation designed to shield consumers from unexpected out-of-network medical bills—may be producing effects opposite to those lawmakers intended. In a statement released Monday, the CBO called for updated research into the law's impact on medical prices, provider network participation, arbiters' decision-making processes, and healthcare markets broadly, citing "emerging evidence" that the law "might not have the effects that CBO anticipated."

When the CBO scored the legislation in 2021, it estimated the No Surprises Act would lower insurers' reimbursement to providers, subsequently decreasing monthly premiums for consumers and the nation's overall healthcare spending. While the law has succeeded in reducing surprise billing and some studies suggest it may have lowered prices for certain services, recent data paints a more complicated picture.

Providers Dominate the Dispute Resolution System

The independent dispute resolution process, established to determine fair reimbursement when providers and insurers cannot agree on out-of-network payments, has become a flashpoint. Under IDR, both parties submit what they believe is a fair price, and a government-certified independent arbiter selects one of the two amounts.

Federal data reveals that providers consistently triumph over insurers, winning 88% of surprise billing disputes. When they prevail, doctors are often awarded three to four times above comparable in-network rates. The volume of disputes has also exploded: while the government initially expected approximately 17,000 cases annually, providers brought 1.2 million disputes in the first half of 2025 alone. As of January 31, 2026, federal regulators reported more than 5.1 million disputes submitted for review since the law's implementation in 2022.

"If providers can systematically secure large payments through the IDR process, they have an incentive to remain out of network or demand higher in-network rates," the CBO wrote, noting that although fewer than 0.05% of claims go to arbitration, they could have an outsized effect on bargaining and drive up negotiated prices over the long term. "An increase in prices would increase premiums for commercial health insurance and, in turn, lead to larger federal deficits."

Insurers Push for Reform

Insurer groups quickly seized on the CBO's call to action. Chris Bond, a spokesperson for AHIP (搜索)搜索该公司, said in a statement: "Provider-driven abuse of the No Surprises Act is adding billions in wasteful spending and raising healthcare costs for everyone. Policy action is needed to address flawed incentives in the IDR process and protect consumers from unconscionable price gouging by some PE-backed providers and IDR middlemen."

The Coalition Against Surprise Medical Billing, an advocacy group backed by insurers and employers, added: "A law that was intended to be a deficit reducer is doing the opposite, and the trend lines are clearly pointing the wrong way. The Trump administration and Congress need to stop the abuse and misuse of the No Surprises Act with commonsense guardrails that ultimately protect consumers and lower their healthcare costs."

CMS Final Rule Seeks Operational Fixes

Amid these concerns, the Departments of Health and Human Services, Labor, and Treasury, together with the Office of Personnel Management, recently issued the Federal Independent Dispute Resolution Operations Final Rule. The rule does not fundamentally alter patient protections or rewrite the core arbitration framework. Instead, regulators are targeting operational challenges that have contributed to delays, administrative inefficiencies, and eligibility disputes.

Among the most significant changes, the Final Rule reduces the administrative fee from $115 per party per dispute to $15 per party per dispute—a move that may improve access to the IDR process for organizations managing significant volumes of reimbursement disputes. The rule also establishes new communication requirements for payors, modifies open negotiation procedures, revises batching rules, accelerates eligibility determinations, and creates a new Federal IDR Registry.

The Final Rule generally becomes effective 60 days after publication in the Federal Register, though provisions will phase in on different timelines. The reduced administrative fee applies to disputes initiated on or after five business days following publication, while certain batching provisions apply to disputes with open negotiation periods beginning 90 days after the rule's effective date.

Implications Across the Healthcare Landscape

For providers and physician groups—particularly those in emergency medicine, anesthesiology, radiology, pathology, and air ambulance services—the new requirements may affect revenue cycle operations, reimbursement strategies, and administrative workflows. The revised batching provisions may provide additional opportunities to consolidate qualifying disputes, potentially reducing administrative burden.

Health plans and insurers face new compliance obligations, including requirements to provide additional identifying information when issuing initial payments or notices of denial, and to utilize specified claim adjustment and remittance codes. The new Federal IDR Registry will require registration by participating plans and insurers.

For investors and private equity-backed healthcare platforms, the Final Rule carries implications beyond reimbursement. For many provider organizations, IDR-derived revenue represents a meaningful source that can influence financial performance, valuation assumptions, and long-term business planning. Organizations evaluating acquisitions or strategic transactions involving specialties with significant out-of-network reimbursement exposure may wish to assess historical IDR activity and dependence upon Federal IDR recoveries.

Congress has shown little interest in revisiting surprise billing legislation, despite broader bipartisan focus on healthcare access and affordability. However, renewed attentiveness from the CBO—which advises lawmakers on policy—suggests the issue has not been put to rest on Capitol Hill.