What Replacing Federal IDR with Insurer-Calculated Payments Could Mean for Providers

What would the proposal change?

The American Society of Anesthesiologists, American College of Emergency Physicians, and American College of Radiology describe the Lower Premiums, Faster Payments Act as a proposal that would eliminate federal independent dispute resolution and replace it with out-of-network payment rates calculated by health insurers.

This proposal is not current law and has not been enacted. The No Surprises Act's existing patient protections and federal IDR process remain in effect while Congress considers any possible changes.

Why does the coalition oppose insurer-calculated replacement payments?

The coalition argues that independent review provides a necessary check when an insurer controls both the initial payment and the methodology used to calculate a benchmark. Removing that neutral decision-maker could leave providers with fewer ways to challenge an unreasonably low out-of-network payment.

ASA's release attributes three 2025 data points to the organizations' September analysis: insurers failed to participate and lost by default on 24.5% of IDR line items; insurer offers of $1 or less appeared on 8.2% of line items; and nearly 40% of nondefault insurer offers were at or below the QPA. Those figures do not resolve every dispute, but they help explain the coalition's concern about placing more control in the hands of the party setting the initial payment.

Why do the organizations call the bill premature?

The release points to two developments that have not yet been fully absorbed into federal IDR operations. First, the May 2026 IDR Operations Rule has not been fully implemented. Second, the Fifth Circuit's August ruling rejected parts of the federal QPA methodology, including the treatment of so-called ghost rates and certain incentive or bonus payments.

If the benchmark itself is still being corrected and operational reforms are still being introduced, Congress should have a reliable view of those changes before deciding whether neutral arbitration should disappear.

Halkovich Law's commentary

Federal IDR can be improved. The strongest reforms would target documented points of friction while preserving an independent check on payer-controlled pricing.

That means screening out ineligible claims earlier, identifying unusually large outlier awards, requiring meaningful participation from both parties, increasing transparency, and enforcing the obligation to pay final determinations. It also means correcting QPA methodology before using the benchmark as the primary measure of what an out-of-network service should be worth.

Giving an insurer unilateral control over the replacement rate would concentrate two decisions with the same party: the amount of the initial payment and the amount available after a challenge. A neutral reviewer remains important when the parties disagree about the value of the service, the reliability of the QPA, or the evidence supporting each offer.

What would targeted federal IDR reform address?

• Faster identification and removal of ineligible claims before arbitration costs accumulate.
• Closer review of outlier awards and obvious data-entry errors without treating every provider award as suspect.
• Consequences for plan defaults, nominal offers, and failures to participate meaningfully.
• Clearer QPA disclosures and a calculation methodology consistent with governing law.
• Stronger enforcement when unpaid IDR awards remain outstanding after the federal payment deadline.
• Transparent public reporting that distinguishes contested cases from defaults and other procedural outcomes.

Those measures would address specific failures while preserving impartial arbitration for disputes the parties cannot resolve themselves.

What should providers preserve and monitor now?

• The initial payment or denial, remittance advice, and every QPA disclosure.
• The open-negotiation record, both IDR offers, supporting submissions, and evidence of any default.
• The final determination, payment deadline, and proof of complete or incomplete payment.
• Payer-level patterns involving nominal offers, recurring QPA positions, delayed payment, or nonpayment.
• Updates concerning the proposed bill, implementation of the IDR Operations Rule, and QPA guidance following the Fifth Circuit decision.

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Sources and scope

This article is Halkovich Law's original provider-side commentary on an advocacy statement issued by ASA, ACEP, and ACR. Descriptions of the proposed bill and reported percentages are attributed to those organizations. This page provides general information, not claim-specific legal advice, an independently recalculated data analysis, or a prediction of congressional action.