Your money
It’s your money. The law says so
The No Surprises Act gave qualifying claims a route to a second look. Most practices never use it.
What you’re leaving behind
Real money, sitting in closed claims
When your doctors treat an out-of-network patient at a hospital or surgery center, the claim usually gets paid at the insurer’s benchmark, not at yours. The gap between those two numbers is real money, and it sits in a closed claim until someone files. For a busy group it can add up over a year, and most groups never look at it again.
What you get back
The difference, decided by an arbitrator
Federal IDR puts the gap between what the insurer paid and what the claim is worth in front of a certified arbitrator. Nationally, providers win about 85% of decided disputes, and most awards land above the insurer’s number. You keep 80% of what we recover. Nothing is due upfront, and there is no fee on a claim we don’t win.
Eligibility, deadlines, and evidence decide each case individually. We screen before we file and tell you which claims don’t qualify and why.
The law, quick
The No Surprises Act took effect January 1, 2022. Patients can’t be balance-billed for emergency care, out-of-network care delivered at in-network facilities, or air ambulance services. Instead, the provider and the insurer settle it through federal arbitration. It runs baseball style: each side names a number and the arbitrator picks one. It covers commercial and employer plans, not Medicare or Medicaid. 42 U.S.C. § 300gg-111. 45 CFR § 149.510.
The process, short
The insurer pays. You generally have 30 business days from that payment to open negotiation. Negotiation runs 30 more. If it fails, the dispute has to be initiated inside a four-business-day window. The arbitrator’s determination and the payment that follows each have their own clock. Miss the first window and that claim is gone.
The numbers
of disputes decided for the provider, second half of 2025
of awards came in above the insurer’s number
disputes filed by January 2026, against a pre-launch forecast of about 17,000 a year
Figures from CMS Federal IDR public reporting and Georgetown University’s Center on Health Insurance Reforms. National figures, not our results, and not a prediction for any claim.
What changed in 2026
The rules kept moving
The administrative fee dropped. From $115 to $15 per party, effective June 11, 2026.
Batching changed. Up to 50 claim lines can move in one arbitration under a single fee starting November 1, 2026. The prior average batch was about seven.
The benchmark was struck. On August 11, 2026, the Fifth Circuit, sitting en banc, held the insurer benchmark methodology unlawful. New rules will follow, and the process continues in the meantime.
Sources: CMS, No Surprises Act · Federal IDR Operations final rule · CMS implementation timeline and notices · 42 U.S.C. § 300gg-111 · 45 CFR § 149.510
Or call
(201) 781-5037