Law meant to protect from surprise medical bills may drive up insurance costs

A law aimed at making healthcare more affordable may actually be driving up premiums, according to a new Georgetown University study.

Researchers found that the No Surprises Act, a law addressing the issue of surprise medicalbillingsituations for care received out-of-network,has driven up arbitration costs between doctors and insurers, hitting $22.4 billion in 2025.

And the study found evidence that those costs are a reason for employers and insurers to raise premiums. The findings were shared on Wednesday in Health Affairs.

We actually think our estimate is conservative, said Jack Hoadley, one of the authors of the study and a professor at the universitysMcCourt School of Public Policy.

TheIndependent Dispute Resolution (IDR) process brings in a neutral third party to consider the best paymentwhenaninsurerand provider cannot reach an agreement. The arbiter thenasks both sides tosubmitproposals with supporting documentation, and then that same arbiter selects the winning proposal while weighingseveralfactors. The losing partyalso paysadditionalfees. In 2025, the median provider award was 445% higher than averages paid by in-network insurers to providers.

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Researchers also noted that costs havenotprimarily been drivenbyprovidersthe bill was intended totarget,such as air ambulance services.Instead,surgeons and neurologistsmadeupmostdisputes, andawards decided by arbiters in thosenegotiationsseem to have no limit.

The time may, in fact, be ripe to revisit[the law]to realize the law's original cost containment goals without jeopardizing the consumer protections that are really the main reason this law got passed in the first place,he said.

Despitehigh costs,researchersnotedthatthe law is technically working. According to the study, providerswon approximately 85% of disputes in 2025.But researchers warnthose costsare likely to weigh on insurance premiums of everyday Americans.

The study follows acallto action by the nonpartisan Congressional Budget Office over the summer, which noted that the law might not have the effects expertsanticipated.