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The No Surprises Act’s arbitration process awarded close to $15 billion to providers in 2025, according to a Wall Street Journal analysis of federal data, marking a dramatic escalation in No Surprises Act arbitration payouts since the program’s early years.
How Much No Surprises Act Arbitration Payouts Grew in 2025
Payouts through the independent dispute resolution process reached $14.85 billion in 2025, up from just $4.08 billion in 2024, the Journal reported. Arbitration firms collected about $1.3 billion in fees last year, a figure that itself has grown substantially alongside the overall payout increase.
CMS’s Response to the Rising Figures
“This law is critical for protecting patients from receiving surprise bills,” a CMS spokesperson told the newspaper. “While patients are now protected from surprise bills, the system is being gamed to get higher prices, and CMS is actively working to clean it up.” The No Surprises Act, enacted in 2020, shields patients from unexpected bills for out-of-network emergency care and certain other services and routes the resulting payment disputes into arbitration.
The Data Behind These No Surprises Act Arbitration Payouts
CMS posted the third- and fourth-quarter 2025 arbitration data July 22. Certified entities issued about 2.2 million payment determinations last year, with more than 1.1 million of them in the second half, according to CMS. Disputing parties initiated about 1.4 million disputes from July through December, a 16% increase over the first six months of the year.
Providers Prevailed in the Vast Majority of Cases
Providers, facilities and air ambulance services prevailed in about 85% of second-half determinations, and the prevailing offer exceeded the qualifying payment amount in roughly 87% of cases. The three most active filers, HaloMD, TeamHealth and SCP Health, accounted for about 38% of disputes initiated in the second half of last year, highlighting how concentrated dispute volume has become among a small number of entities.
Insurer Pushback Against Rising No Surprises Act Arbitration Payouts
The figures come as insurers have been intensifying their rhetoric against the IDR system. On July 16, Dan Kueter, CEO of UnitedHealthcare’s commercial business, said the process “is not working” and “needs to be reformed,” describing it as exploited by certain providers. He said arbitration now accounts for at least 100 basis points of the company’s total commercial cost.
Dispute Volume Far Outpaces Original Projections
UnitedHealthcare told Becker’s it is seeing roughly 100,000 disputes a month, far above the roughly 22,000 a year CMS originally projected for the entire industry when the process launched, a gap that underscores how dramatically the scale of No Surprises Act arbitration payouts has exceeded initial expectations.
Courts Continue Rejecting Insurer Claims About Gaming
Over the last few months, federal courts have largely rebuffed insurers’ claims that providers are gaming the process. Earlier this month, a federal judge dismissed with prejudice an Elevance Health lawsuit accusing HaloMD and two physician groups of defrauding its Blue Cross Blue Shield of Georgia plan through arbitration.
A Pattern Across Multiple States
Judges in California and Texas threw out similar suits against HaloMD in April and May, establishing a consistent pattern of judicial reluctance to intervene in arbitration outcomes despite insurers’ repeated legal challenges questioning the legitimacy of rising No Surprises Act arbitration payouts.
Recent Regulatory Changes to the Arbitration Process
The Trump administration finalized an overhaul of the process in late May, establishing a centralized disputes portal, creating a federal payer registry, and cutting per-dispute administrative fees from $115 to $15, changes aimed at streamlining the system even as the underlying payout totals continue climbing.
What This Means Going Forward
With No Surprises Act arbitration payouts nearly quadrupling year over year, providers continuing to win the vast majority of disputes, and courts consistently declining to side with insurers’ gaming allegations, pressure is likely to keep building for a legislative rather than judicial solution to the underlying tension. As CMS continues implementing its centralized portal and reduced administrative fees, the coming quarters will reveal whether these procedural reforms meaningfully affect dispute volume and payout totals, or whether the fundamental dynamics driving this escalation remain largely unchanged.
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