A running reference for the No Surprises Act as it actually plays out — regulatory guidance, litigation, arbitration data, and market shifts, tracked as they happen.
Dispute volume per CMS Federal IDR bi-monthly report (as of May 31, 2026) — see the IDR Statistics page for the full trend. Median award figure per Jack Hoadley & Kennah Watts, Georgetown CHIR/Health Affairs Forefront analysis of CMS Federal IDR Public Use Files (Aug. 2026).
A running log of regulatory, legal, and market developments.
In East Coast Advanced Plastic Surgery, LLC v. Cigna Health & Life Ins. Co., the Second Circuit (Park, J., joined by Leval, J., and Rakoff, D.J., sitting by designation) affirmed dismissal of a provider's suit seeking to force Cigna to pay more than $3 million in IDR awards it had won but Cigna never paid. The court held the NSA's text and structure show no implied private right of action to enforce IDR payment awards: Congress wrote the NSA into ERISA, the Internal Revenue Code, and the Public Health Service Act, and gave enforcement authority in each case to a federal agency (DOL, Treasury, and HHS, respectively) and to states — not to providers in federal court. That reasoning lands directly on the debate over the No Surprises Act Enforcement Act: this ruling is effectively a judicial confirmation that, absent new legislation, a provider stiffed on an IDR award has no private lawsuit to fall back on — only agency enforcement, which is exactly the gap that bill is trying to close.
Sen. Bill Cassidy (R-LA), outgoing chair of the Senate HELP Committee and an original author of the NSA, is drafting legislation to rework the law before he leaves office. HELP is running stakeholder roundtables this month with doctors, insurers, employers, and independent arbitrators, followed by a full-committee roundtable and a November hearing expected to include HHS testimony. Ideas reportedly on the table: curbing the arbitration backlog by screening out ineligible claims up front, enforcing payout timelines, and creating payment tiers to prevent lopsided awards. The House is taking a narrower path — Ways and Means is largely deferring to Rep. Greg Murphy's No Surprises Act Enforcement Act, which targets insurers that don't pay after a binding IDR determination. Both chambers are racing a tight pre-midterm calendar, and some staff already expect a real fix to slip to the next Congress.
Energy and Commerce Committee Ranking Member Frank Pallone (D-NJ) sent oversight letters to six certified IDR entities — C2C Innovative Solutions, Commence, Dane Street, EdiPhy Advisors, National Medical Reviews, and ProPeer Resources — questioning whether arbitration is "functioning as Congress intended." Pallone cited winning offers that "far exceed commercial payment rates" and pointed to rising premiums, while also flagging IDR entities' lack of responsiveness to prior document requests. Separately, the bipartisan No Surprises Act Enforcement Act (H.R. 4710) remains pending before three House committees — Ways and Means, Education and Workforce, and Energy and Commerce — more than a year after introduction, with Ways and Means continuing its multi-year pattern of NSA implementation oversight. Together, these signal that Congress is actively weighing both stronger enforcement of IDR outcomes and closer scrutiny of the arbitrators making them.
Before the No Surprises Act, an out-of-network bill for emergency or ancillary care often landed on the patient. Now the provider and the payer settle it directly — through negotiation or, failing that, a federal arbitration process. That shift didn't remove the cost from the system. It moved the dispute upstream, into claims administration, stop-loss contracts, captive reserves, and plan sponsor budgets — and it keeps evolving as courts and regulators weigh in. This site tracks that evolution and defines the terms as they come up.