WASHINGTON – David Merritt, senior vice president of External Affairs at the Blue Cross Blue Shield Association (BCBSA), released the following statement after the finalization of the Independent Dispute Resolution (IDR) Operations Rule under the No Surprises Act:
“We applaud the Trump administration’s focus on fixing the IDR process. This rule makes meaningful progress to reduce administrative burdens and streamline the process. We encourage leaders to use this positive momentum to take additional actions—focusing on solutions to stem the flood of ineligible claims into arbitration and awards that often far exceed what providers typically receive for a service. Cracking down on abuse, eliminating waste and delivering more transparency will save money for consumers and businesses.
“Independent research found the broken process added at least $5 billion in healthcare spending in just two years, which ripples through the system raising premiums and out-of-pocket costs for everyone.
“These costs are driven by a small number of private equity-backed providers and middlemen. Four such groups accounted for 56% of total volume in the first half of 2025. One—HaloMD—alone drove 22% and was created solely to exploit IDR. Many of the disputes submitted by these groups don't qualify for the process but are still required to be paid out.
“An analysis from AHIP and BCBSA found that nearly 40% of disputes sent through this process were ineligible, yet roughly half of them resulted in mandatory and often grossly inflated payments. The arbitrators are incentivized to keep these claims in the process – and to decide in favor of the provider – to drive volume. That’s how they get paid.
“The final rule is crafted to address long-standing operational issues with the process. Action is needed to build on these improvements and address these issues that are contributing to our nation’s health care affordability crisis.
“BCBSA has long advocated for a more balanced IDR process. We’ve put forth specific recommendations that would better align incentives and stop bad actors from gaming the system so the cost of care can be lowered for everyone.”
About Blue Cross Blue Shield Association
The Blue Cross Blue Shield Association is a national federation of independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans.