Prices Rose After No Surprises Arbitration for some Care: Analysis

Why It Matters

The findings suggest the IDR mechanism may be inflating healthcare costs, potentially driving higher insurance premiums and prompting renewed regulatory scrutiny.

Key Takeaways

• Imaging arbitration prices 767% above Medicare rates
• Providers won over 90% of imaging arbitrations in 2024
• Team Health and SCP Health dominate emergency arbitration claims
• Radiology Partners filed >90% of imaging arbitration items
• IDR may generate $5 billion in costs through 2024

Pulse Analysis

The No Surprises Act was hailed as a consumer‑protective measure, aiming to shield patients from surprise out‑of‑network bills by mandating an independent dispute resolution (IDR) process. Under IDR, insurers and providers submit competing payment offers, and a neutral arbitrator selects one. While the framework promised transparency, the Brookings Center’s latest analysis reveals that the arbitration outcomes are often skewed toward provider‑driven pricing, especially in high‑margin services like imaging and pediatric critical care.

A deep dive into 2024 data shows imaging prices after arbitration soaring 767% above Medicare rates, dwarfing the pre‑law 200% premium. Providers captured more than 90% of arbitration decisions, submitting offers that were roughly 850% above Medicare, while insurers’ offers hovered around 262%. Private‑equity‑backed entities—Team Health, SCP Health, and Radiology Partners—filed the bulk of arbitration line items, effectively flooding the system with high‑value claims. The contested qualified payment amount (QPA), intended as a neutral benchmark, remains lower than historic in‑network rates, further tilting the playing field toward providers.

The cost implications are significant. An earlier Health Affairs study estimated that IDR added $5 billion to the healthcare system between 2022 and 2024, a burden likely to be passed on to consumers through higher premiums. Policymakers face pressure to recalibrate the arbitration formula, perhaps by tightening QPA calculations or introducing caps on provider offers. As the debate intensifies, insurers, providers, and legislators must balance the original consumer‑protection goals with the emerging reality of escalating arbitration‑driven costs.