How Has the Federal Process for Surprise Medical Billing Disputes Performed?

In late 2020, Congress passed and President Trump signed the No Surprises Act establishing new federal protections for consumers from surprise medical bills. The law became effective in 2022. A significant component of the law was to hold consumers harmless for surprise, out-of-network medical bills by creating a process where the medical provider and health plan would negotiate a payment for the service provided or end up in an independent dispute resolution (IDR) process.

This analysis examines the share of out-of-network surprise billing disputes initiated through the federal IDR process in the first year of the No Surprises Act. About 1 in 8 of these disputes resulted in payment determinations. The federal government recently proposed several changes, with the goal of making the IDR process more efficient and increasing early communication between the parties.

The analysis is available through the Peterson-KFF Health System Tracker, an online information hub that monitors and assesses the performance of the U.S. health system.