No Surprises Act Arbitration: Risk of Dispute Flood and Its Impact on

The No Surprises Act arbitration process might be causing more harm than good. A new final rule, issued on Thursday, May 28, 2026, aims to fix the process, but experts warn it doesn't address the core problem: provider gaming that's costing millions of dollars annually. This article delves into the science behind the rule, its implications for patients, and how you can navigate this complex system.

The Science

The No Surprises Act was designed to protect patients from unexpected medical bills when they receive care from out-of-network providers in emergencies or certain scheduled services. However, its arbitration process, known as independent dispute resolution (IDR), has become a battleground between insurers and providers. Providers are using arbitration as a first resort, not a last one, leading to a flood of disputes that overwhelms the system. According to data from the Centers for Medicare & Medicaid Services (CMS), over 500,000 arbitration cases were filed in 2025, a 40% increase from the previous year.

The new final rule, issued by the Trump administration, makes changes to improve communication between insurers and providers and give Medicare more visibility into negotiations. For example, it now requires parties to exchange information about initial payments before resorting to arbitration. However, according to Jennifer Jones, senior director of legislative and regulatory policy at the Blue Cross Blue Shield Association, "additional action is needed to address the underlying incentives driving overuse of the process." The rule does not eliminate the ability of providers to file disputes with inflated amounts, perpetuating the problem.