National and state medical societies, including ASGE, are asking the Trump Administration to increase enforcement efforts and require greater transparency in the independent dispute resolution (IDR) process as required under the No Surprises Act. Among the problems identified in an April letter to the Administration are:
- Payers increasing patient cost-sharing amounts after an IDR decision in the physicians’ favor;
- Payers reopening final IDR decisions as a way to withhold payment from physicians without sufficient reason;
- Ineligible claims are making their way into the IDR process;
- Lack of Transparency into Qualified Payment Amount (QPA) Calculations; and
- Failure of health plans to reconcile payment outside of the statutory 30-day window following an IDR decision.
The medical society letter coincides with an April 22, 2026 New York Times article that reported on abuses of the IDR process, including claims that should not be eligible for arbitration. According to the New York Times, when the No Surprises Act was signed into law, it was estimated about 17,000 cases would go to arbitration per year. In the first half of 2025, physicians brought 1.2 million such cases forward.
Payers are taking action to curb what they view as misuse of the No Surprises Act IDR process. As previously reported by , Elevance Health, through its Anthem plans, is broadening a “nonparticipating provider” policy that penalizes in-network hospitals when out-of-network clinicians are involved in non-emergent care for Anthem members.
ASGE is closely monitoring developments and will advocate as necessary to encourage more transparency into the IDR process fight against policies that unfairly penalize gastroenterolgists as a result of potentially abusive use of the IDR process by a small subset of providers.