The No Surprises Act: Dismissal Rates for Out-of-Scope and Ineligible Disputes
Thirty-eight percent of disputes submitted for Independent Dispute Resolution (IDR) under the No Surprises Act (NSA) were out of scope, and another 31 percent were procedurally ineligible for IDR. Only 36 percent of these out-of-scope and ineligible disputes were dismissed by IDR entities (IDREs) as required by law.
The NSA, which protects patients from unexpected medical bills, established an IDR process to resolve payment disputes between plans and providers for certain out-of-network services. This study analyzed approximately 200,000 disputes for Elevance Health-affiliated health plans received by IDREs in 2025 to quantify out-of-scope and ineligible disputes and their dismissal rates.
There was variation in dismissal rates by service provided, the reason a dispute was cited as out of scope or ineligible, and IDRE, but all sub-analyses showed out-of-scope or ineligible disputes improperly receiving payment determinations. These findings suggest that policy reforms aimed at modifying the process for identifying and dismissing out-of-scope and ineligible disputes could improve the IDR process.
Related Public Policy Research
The No Surprises Act: Independent Dispute Resolution for Planned Procedures
This study found that provider payments from the No Surprises Act’s Independent Dispute Resolution (IDR) process for certain planned out-of-network procedures far exceeded in-network commercial and Medicare benchmarks. Policy changes are needed to align IDR outcomes with the law’s original intent and prevent excess costs.
Arbitration Outcomes for Out-of-Network Medical Bills Under the No Surprises Act
This study, published in INQUIRY: The Journal of Health Care Organization, Provision, and Financing, compared final payments for out-of-network care from disputes that underwent arbitration under the No Surprises Act in 2023 to commercial in-network rates and Medicare rates.
Provider Charges and State Surprise Billing Laws: Evidence from New York and California
This study published in Health Affairs examined how out-of-network (OON) provider charges changed following the passage of New York and California’s surprise billing laws compared with states without a surprise billing law.