Arbitration United States

Georgetown Analysis: No Surprises Act Arbitration Awards Raise Healthcare Costs in U.S.

By ADR Journal Editorial Desk Published 1 source Arbitration Healthcare Disputes Insurance Premiums No Surprises Act Payment Disputes United States United States

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TL;DR

  • Federal arbitration under the No Surprises Act has cost $22.4 billion since 2022.
  • In 2025, providers won 85% of arbitration cases, with payouts quadruple median in-network rates.
  • Case volumes and awards have risen far above initial government projections.
  • Insurance premiums may rise as a result, according to insurers and state budget reports.

Overview

A Georgetown University report finds that the federal arbitration process resolving out-of-network medical billing disputes under the No Surprises Act resulted in over $22 billion in awards and costs since 2022. Medical providers, particularly three major organizations and a middleman firm, have won the majority of cases, leading to concerns that these outcomes may contribute to higher health insurance premiums in the United States.

What Happened

A Georgetown University analysis published in Health Affairs Forefront reports that the federal arbitration process initiated by the No Surprises Act has resulted in over $22 billion in payouts and related costs since 2022.

The report highlights a substantial increase in arbitration cases, with medical providers winning approximately 85% of disputes and often receiving payments well above the median in-network rates.

Driven by their success, providers have been filing significantly more arbitration cases, with filings increasing 77% from 2024 to 2025. In 2025 alone, arbitration-related payouts reached $16.6 billion-more than triple the prior year.

The analysis finds that a majority of these arbitration awards involved three physician organizations and a middleman, with HaloMD claiming nearly $2 billion in awards for providers.

As arbitration costs have mounted, some health insurers and state agencies attribute rising insurance premiums to these awards. Notable examples include New York State's health plan and union health plans citing arbitration as a primary factor in recent premium increases.

Context

The No Surprises Act was enacted to prevent surprise medical bills for patients treated by out-of-network providers, particularly in emergency settings.

Instead of direct billing to patients, disputes over payments are resolved through a mandatory arbitration process, with arbitrators required to select either the provider's or the insurer's proposed payment amount.

The Congressional Budget Office originally projected that the law's approach would save money and possibly lower premiums, but recent analysis indicates the outcome may be the opposite.

Why It Matters

  • The arbitration process, intended to protect consumers from surprise billing, appears to have shifted costs to insurers and potentially to consumers through higher premiums.
  • The scale and outcomes of arbitration differ substantially from initial policy expectations, raising questions about policy effectiveness and long-term impact.
  • Major provider organizations and specialist firms are dominant users and beneficiaries of the arbitration process, influencing dispute volumes and financial flows in the U.S. healthcare system.

Sources

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