POPIEL: When a law protecting patients ends up costing them more

December 16, 2025 54

If you’ve gone to a hospital that’s in your insurance network, you probably assume every doctor you see there is also in-network. That used to be a risky assumption. Before 2022, many patients were shocked to get massive medical bills after getting care from doctors who, unknown to them, weren’t in their insurance network, even though the hospital was.

To fix this, Congress passed the No Surprises Act. It was designed to protect patients from these surprise bills, and to its credit, it has primarily done so. While the law has helped patients avoid unexpected charges on the front end, it has created new problems behind the scenes that could end up costing you in the long run.

Here’s what’s happening: Even though the NSA stops doctors and hospitals from billing patients directly when there’s a disagreement over pricing, it doesn’t stop them from going out of network. When doctors and insurers can’t agree on how much a service should cost, the law sends them into a kind of arbitration process, like we’ve seen in baseball contract disputes, where each side submits a number, and a third party picks one.

This process is called Independent Dispute Resolution (IDR). Unfortunately, it hasn’t worked as intended.

So far, arbitrators have mostly sided with hospitals and doctors (more than three-fourths of the time). They’re choosing prices that are often 50 percent higher than what’s normally paid for in-network care. That might not sound like your problem, after all, you’re not paying that bill out of pocket.

Here’s the catch: Higher prices in arbitration mean higher costs for everyone, including through higher insurance premiums. And it’s getting expensive. One estimate says IDR has added at least $5 billion in costs to the healthcare system. These extra costs eventually land on the shoulders of businesses, employers, and families — in other words, you.

Even worse, this system creates a dangerous incentive. Some doctors are choosing to stay out-of-network on purpose, knowing they’ll likely get more money in arbitration than they would under a negotiated insurance contract. If this keeps up, more doctors will stay out-of-network, making it harder for people to find covered, affordable care.

There are ways to fix the system. Arbitration decisions should be tied more closely to the average in-network rates that insurance companies pay. That would keep things fair and prevent inflated payouts. More importantly, hospitals should be required to contract with in-network doctors, especially in emergency rooms and hospital-based specialties. If a hospital is in-network, the care you get there should be, too.

The No Surprises Act was a well-intentioned law. It stopped the worst billing abuses. However, the current arbitration process is placing alarming pressure on the system, resulting in higher costs and fewer choices. If we don’t fix it soon, these “surprise medical bills” may just sneak in through the back door, as higher premiums and narrower networks.

It’s time to hold hospitals and doctors accountable and ensure that patient protections don’t become loopholes for profit. Patients should be protected not only from surprise medical bills but also from rising costs.