Elevance Health Study Flags No Surprises Act Dispute Process Inflating Costs
Event summary
- Elevance Health's Public Policy Institute study analyzed 7,300 payment disputes under the No Surprises Act for planned procedures.
- Providers won 89.5% of disputed claim lines, with average IDR awards nearing $40,000—far exceeding in-network and Medicare rates.
- IDR awards for these procedures increased 43% between 2024 and 2025.
- High-dollar disputes often involved scheduled services like spine and plastic surgery.
The big picture
The No Surprises Act has successfully shielded patients from surprise bills, but Elevance Health's study reveals unintended consequences in its dispute resolution process. The findings suggest that the system is being used to inflate costs for planned procedures, raising concerns about whether the law’s original intent is being undermined. With federal IDR volume surpassing initial projections, policymakers may need to intervene to realign the process with cost-control goals.
What we're watching
- Regulatory Adjustments
- Whether Congress will amend the No Surprises Act to curb cost inflation from IDR awards for planned procedures.
- Cost Shifts
- How higher arbitration awards will impact employer premiums and working-family healthcare expenses.
- Provider Behavior
- The pace at which providers exploit the IDR process for scheduled services, further distorting market rates.