US No Surprises Act arbitration faces 2.6 million cases and rising costs

The No Surprises Act, passed by Congress in 2020 and effective in 2022, was created to stop patients from receiving unexpected bills after emergency care from out‑of‑network providers. Disputes over payment are settled through independent arbitration firms that pick either the insurer’s or the provider’s proposed amount. Data from the Centers for Medicare & Medicaid Services show that the system has generated far more cases than expected – about 2.5 million in 2025, far above the original estimate of roughly 17,000 annually. Doctors win roughly 85 % of these arbitrations, leading to large payouts and concerns that the process may be driving up overall health‑care costs. Critics argue that the arbitration model, which forces a winner‑takes‑all outcome, tilts heavily toward providers and could ultimately raise premiums for consumers unless policy adjustments are made.