Apr 26, 2026
The No Surprises Act (NSA) was meant to protect patients from expected medical bills, and while experts say it’s doing its job in that regard, there’s been an unexpected consequence of the law that may be raising the cost of insurance.
The NSA was passed in 2020, with the aim to protect Americans who have health care insurance but get unexpected bills. Surprise billing happens when you unknowingly or unavoidably see an out-of-network provider or get care at an out-of-network facility, and then you are billed directly because your insurance won’t cover the entire cost (1).
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This often occurs after a patient has received emergency care, but it could also happen at a facility that’s in-network while a provider at that facility is out-of-network; for example, you have surgery at an in-network hospital, then receive a bill from an anesthesiologist who is out-of-network.
According to a report from the New York Times (2), while the NSA appears to be working — in that patients are being protected from surprise billing — a costly consequence has arisen: doctors have “flooded the arbitration system with millions of claims.”
Instead of billing patients, doctors — or the owners of their practices — and insurers must turn to arbitration to settle what price will be paid for the care received (3). These arbitrations, carried out by 15 firms hired by the government, have overwhelmingly sided with doctors, according to the Times. But some of the payouts these doctors are receiving are reportedly much more than the typical costs for certain procedures.
As the Times reports, these doctors are “often collecting fees hundreds of times higher than what they could negotiate with insurers directly or what they could have earned from patients before the law passed.”
One plastic surgeon, who is a focus of the Times report, has collected as much as $440,000 for a breast reduction surgery, a procedure that costs between $15,000 to $25,000, according to the doctor’s website (4). Dr. Norman Rowe and his practice, the Times says, have filed more than 6,000 arbitration claims, winning more than 85% of these cases.
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The report also spotlights a Pennsylvania neurosurgery practice that “went to arbitration after the health plan Highmark offered its standard payment of $2,660 for a diagnostic procedure to measure blood flow to the brain.” Instead, the arbitrator awarded the practice $333,000.
Consumers may be paying the price
“This is a recipe for driving up health care costs,” Karen Ignagni, executive chair of EmblemHealth, told the Times.
According to the Times, some health plans have raised premiums this year in response to the extra costs. “The United Service Workers health plan, which covers 20,000 trades workers in the New York area, said it boosted premiums by an extra 1.75 percentage points to offset arbitration awards and fees,” the Times reports.
It’s a bitter pill for Americans who are already being stretched to the limit with cost of living increases and inflation. An employer survey conducted by health research firm KFF found that family premiums for employer-sponsored health insurance climbed 6%, or $1,408, in 2025. And that’s after a 7% increase in each of the previous two years (5).
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What ‘s being done about this?
According to a column published by the Georgetown Law O’Neill Institute, two federal district courts recently dismissed claims brought by insurers (6).
One claim involved HaloMD, an independent dispute resolution (IDR) “middleman that specializes in arbitration,” and the other involved Radiology Partners, “a private equity-backed group of radiology practices.”
The NSA’s requirements for the IDR process, laid out by Congress, say that an arbitrator’s decision “is binding on the parties and not subject to judicial review except in limited circumstances,” the column says.
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“So far, courts have largely concluded that the NSA bars these parties from challenging or otherwise suing over IDR awards and the IDR process.”
While there are other lawsuits making their way through the courts around the country, in the meantime, the federal government may be readying to make changes to the IDR process, the column says.
Proposed changes to the arbitration system from the Biden administration, which included “more scrutiny of ineligible claims,” were not put in place by the Trump administration, according to the Times (2).
The O’Neill Institute analysis says changes similar to those proposed by the Biden administration would “help address some of the concerns reflected in payer lawsuits about the high volume of disputes and the submission of ineligible cases, in particular.”
Article Sources
We rely only on vetted sources and credible third-party reporting. For details, see our editorial ethics and guidelines.
U.S. Department of Labor (1); The New York Times (2); Toulouse School of Economics (3); Norman Rowe MD (4); KFF (5); Georgetown Law O’Neill Institute (6).
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Rebecca Payne has more than a decade of experience editing and producing both local and national daily newspapers. She's worked on the Toronto Star, the Globe and Mail, Metro, Canada's National Observer, the Virginian-Pilot and Daily Press.
