When Congress passed the No Surprises Act, the government estimated its arbitration system would handle about 17,000 payment disputes a year. In the first six months of 2025, providers and insurers filed roughly 1.2 million. That is more than double the same stretch of 2024, and on an annual pace it runs near 140 times what the rule writers planned for. The figures come from Georgetown's Center on Health Insurance Reforms, reading the government's own dispute data, alongside the Congressional Research Service.
Picture a clinic built for seventeen thousand visitors a year that finds millions lined up at the door before lunch. The administrative fees tell the same story: the arbitration process collected about 844 million dollars in fees in that single half year, almost as much as it had collected in the three years before it combined.
A system priced like a rare exception became a routine billing channel, and the side that files keeps winning: providers prevailed in roughly 85 percent of 2024 determinations, so every default is an invitation to file again.