Physician Organizations Oppose Legislation That Gives Health Insurers Unilateral Control Over Out-of-Network Payments

WASHINGTON, D.C. — The American Society of Anesthesiologists (ASA), American College of Emergency Physicians (ACEP) and American College of Radiology (ACR) today expressed strong opposition to the Lower Premiums, Faster Payments Act, legislation introduced by Rep. Frank Pallone (D-NJ) that would eliminate the independent dispute resolution (IDR) process established under the No Surprises Act (NSA) and replace it with payment rates calculated by health insurance companies.

The organizations warned that the proposal would remove a critical independent safeguard against unreasonably low insurer payments while rewarding the very insurance company practices that have contributed to problems with the law's implementation.

“Giving health insurance companies even greater control over physician payments is not the solution to concerns about the IDR process – particularly when health insurers’ own practices are contributing to the problems Congress should be addressing,” said ASA President Patrick Giam, M.D. FASA.

In a September analysis submitted to Congress, ASA, ACEP and ACR documented how insurer practices — including unreasonably low initial payments, flawed Qualifying Payment Amounts (QPAs), and failures to participate in IDR — have contributed to high dispute volumes and undermined the law's operation.

According to federal data cited, insurers failed to participate and lost by default on 24.5% of IDR line items in 2025. Insurers submitted offers of $1 or less on 8.2% of line items, and nearly 40% of insurer offers were at or below the QPA, excluding defaults.

“Smaller and independent practices are often shut out of the IDR process altogether, and continue to face mounting pressures of consolidation as insurers attempt to drive them out of network,” said Ryan Stanton, M.D., FACEP, president of ACEP. “Rewarding insurers for refusing to comply with the law is a misguided approach that will only exacerbate these pressures on independent practices fighting to keep their doors open.”

“Insurers cannot undermine the dispute resolution process and then point to the resulting problems as justification for eliminating it,” said Dana Smetherman, M.D., ACR Chief Executive Officer, “Independent arbiters routinely reject insurers' unreasonably low payment offers. Eliminating arbitration would remove an important check on insurer conduct and threaten the ability of community-based and hospital-based physician practices to negotiate reasonable payment arrangements.”

Legislation is premature

The organizations also emphasized that this bill   seeks to make sweeping changes before recently adopted federal reforms have been fully implemented or the effects of significant court decisions have been addressed.

In May 2026, federal agencies finalized a comprehensive IDR Operations Rule designed to improve transparency, streamline eligibility determinations, strengthen communication between insurers and physicians, and make the dispute process more efficient. Significant provisions have yet to be implemented.

In August, the U.S. Court of Appeals for the Fifth Circuit ruled against key aspects of the federal QPA methodology, including the use of so-called “ghost rates” for services physicians do not actually provide and the exclusion of bonuses and incentive payments from payment calculations. Federal agencies have not fully implemented the changes necessary to bring QPA calculations into compliance with that ruling.

Congress is already considering targeted solutions

ASA, ACEP and ACR noted that constructive discussions are underway in Congress on bipartisan approaches to improve the IDR process. These discussions include strengthening enforcement when insurers fail to pay arbitration awards, reducing ineligible claims entering the process, improving transparency and accountability, and addressing unusually large payment awards or other outliers.

The organizations support meaningful reforms that hold all participants accountable while preserving access to an impartial dispute resolution process.

“There is a better path forward,” said the organizations. “Congress can address legitimate concerns about IDR operations, prevent inappropriate claims and outlier awards, and ensure that insurers pay the awards they owe. None of these improvements requires abandoning independent arbitration or giving insurers greater control over physician payments.”

The No Surprises Act successfully protects patients from unexpected out-of-network medical bills. Its independent dispute resolution process was established to provide a balanced mechanism for resolving payment disagreements between insurers and physicians without involving patients in those disputes.

ASA, ACEP and ACR urge Congress to reject proposals to eliminate independent dispute resolution, implement existing regulatory and court-directed reforms, and continue bipartisan efforts to improve the law.

“Patients are protected from surprise bills. Now Congress must ensure that the payment dispute process works fairly for everyone — not just insurance companies,” the organizations concluded.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 62,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during, and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Follow ASA on Facebook, X, Instagram, Bluesky, and LinkedIn.

THE AMERICAN COLLEGE OF RADIOLOGY
The American College of Radiology (ACR) is a professional association representing more than 40,000 physicians practicing diagnostic radiology, interventional radiology, radiation oncology, and nuclear medicine, as well as medical physicists. Founded in 1923, ACR is the voice of our members, empowering them to serve patients and society by advancing the practice and science of radiological care. www.acr.org.

THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS 
The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education, and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million people they treat on an annual basis. For more information, visit www.acep.org and www.emergencyphysicians.org. 

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