Pallone Seeks Answers from Arbitration Firms on No Surprises Act Compliance

Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ) today sent oversight letters to six companies certified as independent dispute resolution entities (IDREs) under the No Surprises Act, requesting detailed information on how each company is conducting arbitration and complying with the law amid reports of skyrocketing awards and rising consumer costs. The letters were sent to C2C Innovative Solutions, Inc., Commence, Dane Street, LLC, EdiPhy Advisors, LLC, National Medical Reviews, Inc. and ProPeer Resources, LLC.

Pallone was a key leader in the effort to pass the No Surprises Act to shield patients from surprise medical bills and lower health care costs for American families. Since taking effect, the law has protected millions of patients from unexpected out-of-network charges—preventing nearly 20 million surprise medical bills in 2024 alone. However, multiple reports indicate the independent dispute resolution (IDR) process created to resolve payment disagreements between providers and health plans is no longer functioning as Congress intended and is instead driving up costs for consumers.

"For too long, patients were caught in the middle of billing disputes between providers and health plans," Pallone wrote. "While the law has protected millions of families from surprise medical bills, I am concerned that the independent dispute resolution process is not functioning as Congress intended and is resulting in increased out-of-pocket costs and higher premiums for consumers."

Pallone cited a dramatic escalation in IDR case volume, from an initial estimate of 17,000 disputes annually to 2.5 million disputes filed in 2025 and 1.4 million in just the first five months of 2026. Troublingly, most cases appear to have been initiated by a small number of private equity-backed provider organizations, with just 10 initiating parties accounting for approximately 67 percent of cases.

The Ranking Member also raised concerns that a significant share of disputes submitted to IDREs do not appear to meet the law's eligibility requirements, and that arbitrators are awarding payment determinations that are resulting in increased costs for consumers. According to reports, IDREs awarded nearly $15 billion in payments to providers in 2025, with providers prevailing in more than 85 percent of determinations at amounts averaging more than six times local in-network rates, including awards as high as 500 percent of Medicare rates for emergency services and 800 percent of Medicare rates for imaging services.

In the letters, Pallone requested each company provide documents and answers to a series of questions by September 24, 2026, on matters including:

• Annual data on dispute volume, eligibility determinations, and default judgments since 2023;
• Training, credentials, and compensation structures for staff who make eligibility and payment determinations;
• The company's use of automated, algorithmic, or artificial intelligence tools in the dispute resolution process;
• Internal audit and quality review practices, and consistency of outcomes across arbitrators;
• Identification of the 10 organizations that initiated the greatest number of disputes with the company since 2023, along with their dispute volumes and win rates; and
• Disclosure of any financial relationships, ownership stakes, or revenue-sharing arrangements, including private equity or institutional investors, between the IDRE and parties that initiate or respond to disputes it processes.

The full letters are available below:

• C2C Innovative Solutions, Inc.
• Commence
• Dane Street, LLC
• EdiPhy Advisors, LLC
• National Medical Reviews, Inc.
• ProPeer Resources, LLC

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