Insurers Are Undermining the No Surprises Act and Then Claiming the IDR Process Is Broken, New Analysis Sent to Congress Explains

CHICAGO - Unrealistically low initial payments, flawed Qualifying Payment Amounts (QPAs), and impractical contracting terms are among the heavy-handed tactics insurance companies use to push physicians to the independent dispute resolution (IDR) process as a last resort for fair payment, according to an analysis sent to Congress from the American College of Emergency Physicians (ACEP), the American College of Radiology (ACR) and the American Society of Anesthesiologists (ASA).

Centers for Medicare & Medicaid Services data cited in the analysis validates the concerns physicians have voiced about insurance company behavior.

• In 2025, insurance companies failed to even participate in the IDR process and lost by default on 24.5% of IDR line items.
• Insurer offers of $1 or less occurred in 8.2% of line items, and nearly 40% of insurer offers were at or below the QPA excluding defaults.

Physician groups have prevailed in several lawsuits related to the No Surprises Act, with the courts rejecting insurance company practices.

The recent fifth circuit ruling affirms what ACEP, ACR and ASA have been telling Congress and regulators for years-the QPA is unreliable, fundamentally flawed, and used by insurers to game the system, drive down payments and narrow physician networks.

"Patients and physicians should not be blamed for problems created by insurance company business decisions," said ASA President Patrick Giam, M.D., FASA. "When insurers choose to pass the cost of reasonable physician payments on to patients and employers rather than absorb those costs within their substantial revenues and profits, that is a choice to preserve their bottom line, not evidence that the No Surprises Act is failing. Patients deserve a system that protects their access to care and ensures the physicians who treat them are paid fairly."

Congress should address true outliers without allowing insurers to use them as justification for weakening the dispute process or further squeezing community-based physician practices to boost their profits, the organizations said. Additionally, they are calling on Congress to strengthen enforcement of insurer obligations, scrutinize repeated defaults, extreme offers and QPA calculations, and preserve the balanced IDR framework established by the No Surprises Act.

"A fair and effective IDR process depends on accurate payment data, transparency, and accountability from all stakeholders," said ACR CEO Dana H. Smetherman, M.D., MPH, MBA, FACR. "The process has been hampered by insurers refusing to negotiate fair rates, offering inadequate reimbursement, and artificially narrowing physician networks, rather than fully participating in good faith."

"The No Surprises Act must be enforced, not undermined," said ACEP President L. Anthony Cirillo, M.D., FACEP. "Insurers are ignoring the letter and spirit of the NSA. Congress should not look past insurers' role in driving IDR claim volume and then failing to participate in the process. More can be done to strengthen NSA enforcement and hold insurers accountable when they routinely fail to follow the law."

About the American Society of Anesthesiologists
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 60,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during, and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org . To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment . Follow ASA on Facebook , X , Instagram , Bluesky , and LinkedIn .

About the American College of Emergency Physicians
The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education, and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million people they treat on an annual basis. For more information, visit www.acep.org and www.emergencyphysicians.org .

About the American College of Radiology
The American College of Radiology (ACR) is a professional association representing more than 40,000 physicians practicing diagnostic radiology, interventional radiology, radiation oncology, and nuclear medicine, as well as medical physicists. Founded in 1923, ACR is the voice of our members, empowering them to serve patients and society by advancing the practice and science of radiological care. www.acr.org .

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