The Coalition Against Surprise Medical Billing has launched a six-figure advertising campaign urging policymakers to reject the No Surprises Act Enforcement Act.
The coalition argues the legislation would reward stakeholders it accuses of abusing the independent dispute resolution process established under the original law.
The No Surprises Act requires insurers and providers to attempt 30 days of negotiations before either side can take payment disputes to independent dispute resolution, known as IDR.
Under the IDR process, a neutral arbitrator selects one of the parties’ payment offers to resolve disputes that cannot be settled through direct negotiation.
Critics within the industry argue that the IDR process has been abused by some providers, with what was intended as a last resort instead seeing an explosion in cases.
Providers have been winning the vast majority of IDR cases at significantly inflated payment levels, according to the coalition, which represents employers and health insurers.
The coalition contends the No Surprises Act Enforcement Act would “double down” on existing flaws by imposing extra costs on employers and health plans for any delay in final payments, including interest.
A report released by the Blue Cross Blue Shield Association and AHIP in October 2025 suggested that 39% of claims submitted to IDR were not eligible for the process.
Members of the Coalition Against Surprise Medical Billing include AHIP, BCBSA, the ERISA Industry Committee, the Business Group on Health, the Purchaser Business Group on Health, and a number of regional employer groups.
Several of these organisations and leading employers sent a letter to key representatives last week warning that the bill would “exacerbate the affordability crisis” facing patients and working families.
“While the law has protected patients from the immediate cost of surprise medical bills, implementation of the law has fallen far short of the equally important goal of making health care more affordable,” the letter stated.
“Instead, the profit-driven use of the IDR process by certain provider groups and middlemen is causing health care costs to spiral even higher, and employers, working families, patients and consumers are paying the price,” they added.
The coalition’s new video advertisement states: “Across the country, out-of-network providers are exploiting the No Surprises Act, gaming an arbitration system meant to protect patients, enforcing you to pay higher healthcare costs.”
The ad continues: “Congress passed this law with good intentions. Now it’s being abused. Congress should fix the loophole, not expand it.”
On the other side of the debate, supporters of the legislation, formally designated H.R. 4710/S. 2420, argue it would authorise penalties for any party failing to comply with statutory payment timelines following a final IDR determination.
Proponents say the bill would also provide federal regulators with explicit authority to enforce IDR decisions and restore the balance Congress intended when it enacted the No Surprises Act in 2020.
In a letter sent to congressional leaders in May, the AMA, 50 state medical societies, and 46 healthcare groups announced support for the bipartisan bill, underscoring the sharp divide between insurers and medical providers on the issue.