While the No Surprises Act protects patients from unexpected medical bills, its independent arbitration system generated $17 billion in consumer costs in 2025. Nonprofits designated as dispute arbitrators, such as Michigan-based iMPROve Health, turned severe financial losses into 13-fold revenue growth and 70% profit margins. Policy analysts call on Congress to reform the lucrative system as both political parties prioritize affordability.
Arbitration fees enrich resolving entities
- ▪Nonprofit arbitrators operating under the No Surprises Act generate substantial financial returns by charging fees to resolve billing disputes between insurers and providers.
- ▪The No Surprises Act arbitration framework enriches independent arbitration entities, healthcare providers, and third-party middlemen resolving payment disputes.
Financial turnaround of iMPROve Health
- ▪Prior to obtaining its No Surprises Act arbitration contract, iMPROve Health instituted budget cuts, closed its physical office to go remote, and discussed potential merger or acquisition options.
- ▪Michigan-based nonprofit iMPROve Health lost over $2 million in fiscal year 2022, representing over a third of its revenue, before securing a government-backed arbitration role under the No Surprises Act.
- ▪Following its appointment as a No Surprises Act arbitrator, iMPROve Health increased its revenue 13-fold and achieved a 70% profit margin.
- ▪The 70% profit margin achieved by No Surprises Act arbitrator iMPROve Health rivals the profit margins of major technology corporations such as Nvidia.
Paragon Health Institute findings and recommendations
- ▪The No Surprises Act's Independent Dispute Resolution arbitration system cost Americans nearly $17 billion in 2025, according to Paragon Health Institute analysts Jackson Hammond and Brian Blase.
- ▪Paragon Health Institute analysts Jackson Hammond and Brian Blase proposed that Congress reform the No Surprises Act arbitration system to reduce unintended financial costs.
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