Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-New Jersey) sent oversight letters on Thursday to six independent dispute resolution (IDR) entities calling for more information about how they’re complying with the No Surprises Act. The entities include C2C Innovative Solutions, Commence, Dane Street, EdiPhy Advisors, National Medical Reviews and ProPeer Resources.
The No Surprises Act protects patients from surprise medical bills by requiring insurers and providers to first attempt 30 days of negotiations before either side can take payment disputes to the IDR process, where a neutral arbitrator (an IDR entity) selects one of the parties’ payment offers.
However, there is growing criticism that the IDR process is not being used in the way Congress intended. It was initially estimated that there would be about 17,000 disputes annually, but 2.5 million disputes were filed in 2025. Most cases seem to be initiated by a small group of private equity-backed providers, according to Pallone’s announcement.
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There have also been concerns that IDR entities aren’t operating the way they should, with arbitrators awarding payments that are leading to rising costs for consumers. For example, IDR entities awarded about $15 billion in payments to providers in 2025, and providers won more than 85% of determinations at amounts more than six times local in-network rates, according to the announcement.
“For too long, patients were caught in the middle of billing disputes between providers and health plans,” Pallone said in the letters. “While the law has protected millions of families from surprise medical bills, I am concerned that the independent dispute resolution process is not functioning as Congress intended and is resulting in increased out-of-pocket costs and higher premiums for consumers.”
In the letters, Pallone called for each company to provide the following information by September 24:
- Annual data on dispute volume, eligibility determinations and default judgments since 2023
- Training, credentials and compensation for workers who make IDR determinations
- Use of AI tools in the IDR process
- Internal audit and quality review practices
- Identification of the 10 organizations that have initiated the most disputes with the company since 2023
- Disclosure of any financial relationships, ownership interests, or revenue-sharing arrangements between the IDR entity and parties involved in the disputes it processes, including private equity and institutional investors
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“I am concerned that some corporate entities are using aggressive tactics to undermine the No Surprises Act, resulting in winning offers that far exceed commercial payment rates and contributing to higher insurance premiums for consumers – the very people this law meant to protect,” Pallone stated in the letters. “Moreover, I am concerned about your lack of transparency with Congress, as my staff has repeatedly requested information from your company about your company’s processes and procedures pertaining to NSA arbitration, and has not received a substantive response.”
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