Representative Pallone Demands Transparency from Arbitration Firms Over No Surprises Act Disputes

Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-New Jersey) has sent oversight letters to six independent dispute resolution (IDR) entities, demanding detailed information regarding their compliance with the No Surprises Act. The targeted entities include C2C Innovative Solutions, Commence, Dane Street, EdiPhy Advisors, National Medical Reviews, and ProPeer Resources.

The No Surprises Act was designed to shield patients from unexpected medical bills by mandating that insurers and providers attempt a 30-day negotiation period before escalating payment disputes to the IDR process. In this process, a neutral arbitrator from an IDR entity selects one of the competing payment offers.

However, critics argue that the IDR process is being misused in ways contrary to congressional intent. While initial projections anticipated approximately 17,000 annual disputes, the system faced a staggering 2.5 million filings in 2025. According to Pallone’s office, the majority of these cases appear to be initiated by a small cohort of private equity-backed providers.

Additional concerns have been raised regarding the operational integrity of IDR entities, with critics asserting that arbitrator decisions are driving up consumer costs. For instance, in 2025, IDR entities awarded roughly $15 billion in payments to providers. Furthermore, providers secured over 85% of determinations, with award amounts exceeding six times the standard local in-network rates.

“For too long, patients have been caught in the crossfire of billing disputes between providers and health plans,” Pallone stated in the correspondence. “While the law has successfully protected millions of families from surprise medical bills, I am deeply concerned that the independent dispute resolution process is failing to function as Congress intended, ultimately leading to higher out-of-pocket expenses and increased premiums for consumers.”

In his letters, Pallone requested that each organization submit 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

“I am concerned that certain corporate entities are employing aggressive tactics to undermine the No Surprises Act, securing offers that far exceed standard commercial rates and driving up insurance premiums for the very consumers the law aimed to protect,” Pallone wrote. “Furthermore, I am concerned about your lack of transparency with Congress, as my staff has repeatedly requested detailed information regarding your arbitration processes and procedures under the NSA, yet has not received a substantive response.”

Photo: KLH49, Getty Images

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