Every year, millions of people receive balance bills—additional out-of-pocket charges after insurance has paid its share—from out-of-network health care providers, facilities, or air ambulance providers, many of which are unexpected, so-called “surprise” bills. In December 2020, Congress enacted the No Surprises Act (NSA), a provision of the Consolidated Appropriations Act, 2021, to protect patients from surprise medical bills in certain circumstances and establish a process for providers and insurers and health plans to determine out-of-network reimbursement.

Overall, the independent dispute resolution (IDR) process has been utilized much more than the Administration projected, with over 490,000 disputes submitted through the IDR internet portal between its start in April 2022 and June 2023—more than 25 times higher than originally projected. As of June 2023, 61% of disputes submitted remained unresolved.

This project was designed to collect a broad range of perspectives from stakeholders and the literature to (1) understand the current state of the implementation of IDR and (2) arrive at a set of productive, broadly supported recommendations—however narrow—for its reform and improvement.

To read the full report, visit here.