A federal fix awards doctors billions. It could mean pricier insurance

For context, a federal fix awards doctors billions. It could mean pricier insurance.

Key points

• The arbitration process cost more than $22 billion in payments to medical providers and related costs since 2022, the analysis remarked.
• The Georgetown analysis discovered more than three-fourths of awards involved three physician and middleman organizations – Radiology Partners, HaloMD and TeamHealth.
• Most Americans obtain health insurance through the workplace, and recent surveys suggest those costs soared this year at the highest levels since 2010.
• 455 individuals, including doctors and nurse practitioners, were charged in connection with global health care fraud schemes totaling $6.5 billion.
• Since arbitration began in 2022, doctors have won a vast majority of cases.

For context, a federal fix awards doctors billions. It could mean pricier insurance. Ken Alltucker USA TODAY. 455 individuals charged in $6.5B global health care fraud schemes.

Notably, a federal fix introduced to settle billing disputes between doctors and health insurers has largely protected consumers from surprise medical bills.

But the solution, an arbitration process, has done little to reduce health care costs. It means consumers could pay in another way – pricier health insurance premiums, according to a new Georgetown University analysis of No Surprises Act arbitration awards.

Notably, the arbitration process cost more than $22 billion in payments to medical providers and related costs since 2022, the analysis remarked. In 2025 alone, the arbitration system cost $16.6 billion, or more than triple the amount paid in 2024, according to the analysis, published Aug. 26 in Health Affairs Forefront.

Congress passed the No Surprises Act in 2020 against the backdrop of growing complaints from patients hit with sizeable medical bills by doctors who weren't in their health insurer's network of providers. The legislation focused on care in hospital emergency rooms and pricey air ambulance rides. A common scenario involved patients who sought care at hospitals in their insurer's network only to be billed by out-of-network doctors, specialists or other medical providers.

While the arbitration system has protected patients from surprise bills, it's accelerated health care spending despite a Congressional Budget Office projection it would save funds and lower insurance premiums, stated Jack Hoadley, a research professor at Georgetown's Center on Health Insurance Reforms and a co-author of the analysis.

"The system has failed to meet that cost-containing goal, " Hoadley remarked. "Enormous (arbitration) costs inevitably add to the insurance premiums paid by consumers, and we've already seen some employers attributing a portion of their premium increases" to arbitration costs. How does arbitration work?

In practice, the law removed patients from these billing disputes. Patients still must pay the copays, coinsurance and deductibles required by their insurance plan, but they should no longer be directly charged the bill's balance.

Doctors who aren't satisfied with the amount the insurance plan offers can seek arbitration. Cases are decided by baseball-style arbitration – a process in which the arbitrator must award either the amount proposed by the insurance plan or what the medical provider asks. The arbitrator can't split the difference; they must award either the insurer's proposed payment or what the medical provider seeks.

Since arbitration began in 2022, doctors have won a vast majority of cases. In 2025, medical providers won 85% of disputes and were awarded payments more than four times the qualifying payment amount. It is defined as the median contracted in-network rate for care, according to the Georgetown analysis.

Perhaps due to their outsized success winning lucrative awards, doctors are increasingly choosing this path to collect payments. In 2025, medical providers brought 2.6 million disputes, up 77% from 2024. That case volume is far more than the federal government's initial estimate of regarding 22, 000 disputes per year.

For context, the medical providers additionally are taking in lucrative awards. In 2025, payments jumped 264% from 2024, the Georgetown analysis remarked.

In practice, the combination of more cases, higher awards and administrative costs have sent the overall cost tag soaring. From 2022 through 2025, the system cost $22.4 billion in extra awards, arbitrator fees and administrative expenses, the Georgetown analysis remarked.

For context, the Georgetown analysis discovered more than three-fourths of awards involved three physician and middleman organizations – Radiology Partners, HaloMD and TeamHealth.

HaloMD, which files disputes on behalf of providers, is the largest middleman organization involved in arbitration cases. The Georgetown analysis remarked HaloMD has "boasted of winning $2 billion in award determinations for provider clients, " and won 90% of cases.

In an official note, HaloMD's Chief External Affairs Officer Patrick Velliky remarked the business "facilitate(s) access to sustainable reimbursement, " for more than 27, 000 doctors and clinicians nationwide.

"We're proud to help provide the means for these groups to remain independent and continue serving their communities, " Velliky remarked.

Radiology Partners, a national radiology doctors practice, remarked in an official note that the Georgetown analysis "misses the mark by failing to address the underlying factors driving physicians to request arbitration in the first place." Radiology Partners quoted a judge who cited insurers "lowball offers to out-of-network providers in an effort to maximize" profits.

TeamHealth, in an official note, remarked the No Surprises Act provides a "workable format" to resolve out-of-network payment disputes while protecting patients. The firm wants to keep the "accessible, balanced and independent" arbitration process while encouraging insurers to fully participate to eliminate default awards. Will arbitration inflate my insurance bill?

While the Georgetown analysis notes there is little evidence examining how the arbitration process is impacting premiums, some insurers, in advocacy materials, court filings and earnings calls, have sounded the alarm on potential impact of how the arbitration awards will swell costs.

Notably, the New York state budget document remarked out-of-network providers are using arbitration under the No Surprises Act and similar state legislation to maximize revenue. The arbitration continued more than $200 million in claim payments to the health insurance plan for state employees and families. The budget document remarked the arbitration awards are a "primary contributor" to the 2027 state health plan's premium rise of almost 10%.

For context, the Georgetown analysis cited two other examples of insurer raising rates. The United Service Workers union plan raised premiums another 1.75 percentage points to offset arbitration awards and fees. A United Healthcare official remarked the arbitration went on 2% to 6% in premium expenses for privately-insured customers. "We're definitely concerned about downstream impacts on premiums, " Hoadley remarked.

Notably, a survey published earlier this month noted more than 4 in 10 adults cited the cost of health insurance as the biggest difficulty that needs to be fixed in the U.S. Health care system. Individuals additionally lamented the amount they spend on co-pays and deductibles for health expenses such as medical bills, lab tests, or prescription drugs. This story has been updated with new information.

Ken Alltucker is a consumer health reporter at USA TODAY; reach him at [email protected]. Share your feedback to support improve our site!

Taken together, the developments around a federal fix awards doctors billions. It could mean pricier insurance point to a situation that is still moving, and the coming days should bring more clarity.