Health insurers defaulted on 24.5% of No Surprises Act independent dispute resolution line items decided in 2025, according to a new analysis of CMS data from the American Society of Anesthesiologists, the American College of Emergency Physicians and the American College of Radiology shared with Becker’s via email Sept. 22.
The groups reviewed 4,667,944 line items decided in 2025 in which the health plan was the non-initiating party. Plans submitted no offer on 1,144,168 of them.
Plans offered $1 or less on another 8.2%, or 382,114 line items. That means 32.7% never received a genuine offer. Offers above $1 but at or below the qualifying payment amount made up another 30.4%. In all, 63.1% of line items never drew a plan offer above the QPA.
The physician groups say these numbers, not providers gaming the system, explain high physician win rates. Arbitrators have to pick the more reasonable of two offers, so a no-show or a $1 bid hands the provider the win. The groups also cite the 5th Circuit’s Aug. 11, 2026, en banc ruling in Texas Medical Association v. HHS. The court found the rule producing the QPA arbitrary, capricious and contrary to law.
In a July 10, 2026, decision, U.S. District Judge Thomas Thrash Jr. wrote that it was “highly plausible” a plaintiff insurer engaged in “a consistent practice of submitting lowball offers to out-of-network providers in an effort to maximize its profits.”
The groups urged Congress to take four steps:
- use CMS data to flag outlier providers, insurers and IDR entities
- audit repeated extreme offers
- require payment within 30 days of a determination
- let the May 2026 IDR operations final rule take effect
They warned against a legislative or regulatory “bailout” for insurers. The analysis pushes back on recent coverage that cites claims volume, provider win rates and large awards as evidence that providers are gaming the IDR process.
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