The No Surprises Act was supposed to lower healthcare costs. Instead, its payment dispute system has generated $22.4 billion in costs in just four years. A new Georgetown study found that 85% of disputes are won by physicians, but the vast majority of payouts are flowing to large provider groups, particularly in specialties such as radiology, emergency medicine, surgery and neurology. In 2025 alone, dispute volume rose 77%, while payment awards surged 264%, pushing total annual costs to $16.6 billion.
The imbalance is striking: Radiology Partners, HaloMD and TeamHealth accounted for more than three-quarters of resolved dispute lines in 2025, while smaller independent practices largely aren’t participating. Primary care has also seen little benefit because the law primarily applies to certain out-of-network care delivered in facility-based settings.
And the financial consequences may ultimately reach patients. Researchers say the growing cost of arbitration could contribute to higher insurance premiums; UnitedHealthcare has attributed a 2%–6% increase in commercial premium expenses to the process, while New York’s state employee plan reported nearly a 10% premium increase, with more than $200 million in additional claims tied to IDR.