Arbitration United States

UnitedHealthcare Calls for Reform of No Surprises Act Arbitration System

By ADR Journal Editorial Desk Published 1 source Arbitration Healthcare Sector Insurance Disputes Public Policy United States United States

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TL;DR

  • UnitedHealthcare executives call for reform of the No Surprises Act arbitration system.
  • Insurer claims independent dispute resolution (IDR) is being exploited by select providers.
  • Provider wins average 11 times Medicare rates in arbitration, contributing to rising costs.
  • Federal courts have so far dismissed lawsuits challenging the arbitration system.

Overview

On July 16, 2026, UnitedHealthcare executives publicly called for significant reform of the No Surprises Act's arbitration system, claiming it is being misused by some providers and is contributing to elevated healthcare costs. The statements came amid ongoing federal litigation, high arbitration volumes, and recent changes to the arbitration framework.

What Happened

During UnitedHealth Group's second-quarter earnings call, Dan Kueter, CEO of UnitedHealthcare's employer and individual business, stated that the independent dispute resolution (IDR) process under the No Surprises Act is not functioning as intended and requires reform.

Kueter reported that about 40% of claims entering the IDR process are ineligible, and 60% of arbitration cases are initiated by only five entities. The insurer asserts that awards obtained by providers through arbitration are, on average, 11 times higher than Medicare rates, sometimes reaching 30 times.

Federal courts have recently dismissed several lawsuits by insurers challenging the arbitration process, including a July 10 dismissal of a suit by Elevance Health against HaloMD and certain physician groups. The courts emphasized the limited judicial review available for arbitration decisions.

Despite regulator efforts to control costs and streamline the process-such as fee reductions and a centralized portal-UnitedHealthcare maintains that the system continues to drive higher commercial insurance costs.

Context

The No Surprises Act, implemented in 2022, created a federal arbitration process to resolve payment disputes between providers and insurers for out-of-network medical services. Initial agency projections severely underestimated the volume of disputes filed, with over 5 million cases submitted since the program's start.

Studies cited indicate that providers win a large majority (85%) of arbitration cases, with high awards compared to median qualifying payment amounts. Recent regulatory reforms have not satisfied insurers, who are pressing for more substantial changes.

Why It Matters

  • UnitedHealthcare's call for reform reflects growing concerns among insurers over the financial impact and operation of the No Surprises Act's arbitration process.
  • Ongoing disputes, litigation, and sector lobbying may influence future federal regulatory or legislative action on commercial health insurance costs and dispute resolution processes.
  • The issue is relevant for providers, insurers, and policymakers evaluating balance billing, arbitration fairness, and commercial health cost trends.

Sources

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