UnitedHealthcare Criticizes No Surprises Act’s Dispute Resolution Process
Industry giant UnitedHealthcare has joined the growing number of insurers expressing dissatisfaction with the No Surprises Act’s independent dispute resolution (IDR) process. During a recent earnings call, company executives highlighted concerns about how the current IDR process impacts their commercial business.
Challenges in the Current IDR Process
Dan Kueter, CEO of UnitedHealthcare Employer and Individual, described the process as “ineffective” and noted that it is “being exploited by select providers and select regions.” Kueter believes this exploitation is contributing to rising costs in the commercial market.
“It has existed for some time, the scale of disputes continues to increase, and that has highlighted the shortcomings of the IDR process,” Kueter remarked during the call. He cited data indicating that approximately 40% of claims filed with the IDR are deemed ineligible, and around 60% of arbitrations originate from just 20% of organizations.
Financial Implications of IDR Outcomes
Kueter also pointed out that as providers increasingly win disputes, the payouts from the IDR process have escalated. The average resolution is now about 11 times Medicare rates, with some resolutions resulting in payments up to 30 times higher than Medicare rates.
While there are some geographic differences, as some states have their dispute resolution processes, these trends are generally observed nationwide, Kueter noted. He emphasized that this indicates the IDR process is not functioning as intended for employers of all sizes and needs reform.
Industry-Wide Concerns and Calls for Reform
Kueter’s comments reflect broader industry sentiment. Insurers and leading lobbying groups have criticized the IDR process, which was expected to resolve most disputes through negotiation rather than arbitration. However, data released in September 2025 revealed that the federal IDR portal received 14 times more submissions than anticipated when it launched in 2022, with annual volumes now 100 times higher than the Centers for Medicare & Medicaid Services (CMS) projections.
Last month, the Congressional Budget Office called for further research into the No Surprises Act’s dispute resolution process, cautioning that it might incentivize providers to remain out of network due to their influence over IDR outcomes. AHIP, the main payer industry association, urged lawmakers to reconsider the process, stating that “common-sense policy solutions are needed to restore the intent of Congress and the President when enacting the No Surprises Act: to protect consumers from surprise medical bills and reduce overall health care costs by curbing provider abuse.”
Payers have attempted to legally challenge the companies causing much of the IDR flooding, but with limited success. Meanwhile, providers argue they resort to IDR because payers often undermine them during negotiations.
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