Pillar 04

No Surprises Act / IDR

Independent dispute resolution · QPA · Out-of-network

LowFAH sits with physicians against insurers here. The Fifth Circuit struck the ghost-rate QPA method in August 2026 and the fee fell to $15.

Last verified November 6, 2026

FAH position

FAH supports the No Surprises Act and blames insurer underpayment for dispute volume. It welcomed the 2026 operations rule. It has joined amicus briefs against the QPA-anchored rules and for enforcement of awards.

Where it stands

Status as of November 2026

June 4, 2026The federal IDR operations final rule took effect August 3, 2026. The administrative fee fell from $115 to $15 per party for disputes started on or after June 11, 2026. Plans must disclose QPA information and use standard remittance codes. source
August 11, 2026The Fifth Circuit, sitting en banc, held the QPA may not include ghost rates for services a contracted physician never furnishes. It may not exclude bonus and incentive payments. Exclusion of single-case agreements was upheld. source
January 12, 2026The Supreme Court declined to hear Guardian Flight v. HCSC, leaving the Fifth Circuit's holding that the Act gives no private right of action to enforce IDR awards. source
March 20, 2026Volume: more than 1.46 million federal IDR disputes were started in 2024. Initiating parties won 85% of 2024 determinations and 88% in the first half of 2025. source

FAH on the record

Letters, comments and statements

May 21, 2025FAH's letter to the FTC and DOJ asks the agencies to press insurers to negotiate in good faith and meet IDR requirements. It notes FAH supported the Act at enactment. source
August 28, 2025FAH statement on IDR costs: insurers are costing Americans billions without improving care, and disputes exist because insurers underpay. source
May 28, 2026FAH statement on the operations final rule: it adds transparency, accountability and clearer insurer obligations. source

The evidence

•FAH joined four other hospital groups on a December 2021 brief supporting the AHA and AMA challenge to the IDR interim rule. The others were AAMC, America's Essential Hospitals, the Catholic Health Association and the Children's Hospital Association. source
•FAH joined AHA, AMA and the Texas Medical Association as amici for the air ambulance appellants in Guardian Flight v. HCSC in October 2024. source
•The 2021 interim rule assumed 17,333 disputes a year. 2024 brought more than 1.46 million, 84 times the estimate. source
•CMS: the $15 fee applies to disputes started on or after June 11, 2026; earlier disputes stay at $115. source

What it means for physicians

This is the one pillar where FAH's interest and the independent physician's line up without a catch. Both bill insurers out of network, both lose when the QPA is rigged, and both win when awards are enforced. The gap that remains is enforcement: a physician who wins arbitration still has no federal right to sue for the money.

Sources