Primary source: Paul Fronstin, EBRI Issue Brief, “The Federal Independent Dispute Resolution Process and Employment-Based Health Plan Costs,” November 12, 2026
On November 12, 2026, the Employee Benefit Research Institute published an 11-page issue brief that prices the extra check. Using 2025 CMS federal independent dispute resolution public-use data, Paul Fronstin estimates that IDR awards created $8.39 billion in additional health-plan payment obligations above plans' initial payments, after patient cost sharing. If you bill out of network, that figure is the award sitting on top of what the plan already paid. If you fund the plan, it is about $46 per covered person. EBRI says the percentage is not the No Surprises Act's effect on premiums.
EBRI's full-year estimate of additional employer-plan obligations from 2025 federal IDR awards. About 0.625% of an estimated $1.342 trillion in national employment-based health plan costs. About $46 per covered person per year, or $50 among people under 65. The second half was $4.726 billion. The first half is an estimate of $3.662 billion.
The brief is independent research on federal claims data. It is not a vendor survey, and it is not a CMS scorecard. The method, where the inputs exist, is the selected IDR award minus the plan's initial payment minus patient cost sharing.
| Figure | What EBRI's November 12 page says it is |
|---|---|
| $8.39 billion | Additional health-plan payment obligations in 2025, above plans' initial payments, after patient cost sharing. |
| Method | Selected IDR award, minus the plan's initial payment, minus patient cost sharing where that amount was available. The data are the 2025 CMS federal IDR public-use files. |
| 0.625% | That $8.39 billion as a share of an estimated $1.342 trillion in national employment-based health plan costs. |
| About $46, or $50 | About $46 per covered person per year. About $50 among people under 65. |
| $4.726 billion | The second half of 2025. EBRI's page presents this half as the calculated total from the method above. |
| $3.662 billion | EBRI's estimate for the first half of 2025. Combined with the second half, it produces the $8.39 billion. |
EBRI says the 0.625% measures the financial scale of additional obligations set through federal IDR awards. It is not the overall effect of the No Surprises Act on premiums or health care spending. The figure excludes administrative expenses. It does not capture payment changes for the larger share of out-of-network claims that settle before federal IDR, changes in network contracting, or negotiated rates.
Read the halves off EBRI's page, not off the trade write-up. The issue brief puts $4.726 billion in the second half of 2025 and an estimated $3.662 billion in the first half. Those two amounts are how the page gets to $8.39 billion.
Fierce Healthcare, Paige Minemyer, November 12, 2026, 1:45 p.m., assigns about $4.73 billion to the first half and about $3.66 billion to the second. That is the reverse of the issue brief. This article follows the brief. Fierce's other points are separate, and they are labeled below as Fierce's.
Fierce quotes Paul Fronstin, Ph.D., director of Health Benefits Research at EBRI, and says the lines are from the announcement: “These new data provide a clearer picture of what health plans owe for out-of-network services beyond their initial payments, after accounting for patient cost sharing. Separating those amounts from arbitration awards allows us to measure additional plan obligations more directly.”
Fierce also reports three figures that are not on the EBRI summary page this article uses as primary. Even when analysts used different thresholds to exclude outlier awards, the estimate was at least $8.02 billion. Providers won 85% of disputes last year. There were 2.6 million disputes initiated in 2025. Fierce sets that initiation count next to a federal estimate of about 22,000 cases a year reaching the arbitration phase. Initiated is not the same thing as decided, and neither count is the $8.39 billion. The dollar figure is EBRI's additional obligation on awards, after the initial payment and the patient's share.
Fierce attributes a different perimeter to Georgetown. An analysis from Georgetown University, released in August, estimated total costs associated with IDR at $22 billion in 2025. That $22 billion is Georgetown's, as relayed by Fierce. It is not an EBRI total, and it is not added here to the $8.39 billion. Fierce also writes the 0.625% as about 63 cents per $100 of employer-plan spending. Same ratio, Fierce's rounding. EBRI's page is the one that prints 0.625%.
Fierce's account of the provider argument is worth keeping in its lane. Providers, Fierce writes, say the root cause is payers setting a low qualifying payment amount in the opening negotiation. That sentence is Fierce's report of the provider position. It is not a finding in the EBRI summary.
This is RevCycleAI's operating read. EBRI measured additional plan obligations on federal IDR awards. It did not publish a denial rate, a win rate, a premium impact, or a practice-level yield. The 85% provider win rate and the 2.6 million initiations are Fierce's, not lines we are moving onto EBRI's table.
For a provider revenue-cycle team, federal IDR is no longer a side queue you staff when a bill looks large. EBRI's $8.39 billion is the gap between the selected award and the plan's initial payment, after the patient's cost sharing where that amount was in the file. That gap is out-of-network revenue. It is also the number an employer can put in front of a plan and ask why it exists. Both sides will treat it as real money, because it is an obligation the study derived from awards, not a modeled savings claim.
The file is the work. The method needs three amounts: the award, the plan's initial payment, and patient cost sharing when it is available. A dispute packet that cannot show what the plan paid first, or what the patient owed, is a packet this study could not fully net. EBRI does not say whether missing cost sharing pushes the $8.39 billion up or down. Do not fill that in. Do make the cost-sharing line a required field in the IDR workflow, because the published method uses it when it is there.
Expect the response on the other side of the claim. About $46 per covered person, and about $50 under 65, is small next to a family premium and large as a single arbitration program. EBRI is explicit that this is not the Act's effect on premiums, and that it leaves out admin cost, claims that settled before IDR, network changes, and negotiated rates. An employer reading $8.39 billion will not wait for those missing pieces before it asks the plan to keep more claims out of IDR. A plan reading a process that, on Fierce's account, providers won 85% of the time last year will push on the opening payment and on which claims are allowed to reach a certified IDR entity. Your documentation has to survive that push: the initial payment you are disputing, the qualifying payment amount if you are arguing it, and the cost sharing.
One earlier product note sits on the payer side of this same queue. On July 2, 2026, RevCycleAI wrote that Zelis had introduced an AI tool aimed at payers in No Surprises Act disputes. That piece does not change the $8.39 billion, and it does not report an outcome. It is a reminder that plans are already buying workflow for the dispute you are filing.
$8.39 billion is EBRI's 2025 additional plan obligation from federal IDR awards, above the initial payment and after patient cost sharing. About $46 a covered person. The second half was $4.726 billion and the first half is estimated at $3.662 billion. The 0.625% is the scale of those awards against $1.342 trillion of employer-plan costs. It is not the No Surprises Act's effect on premiums.
Treat federal IDR as a billed revenue workflow with a file standard, and expect the plan and the employer to answer an $8.39 billion line. The dollars EBRI counted are the award minus the initial payment minus the patient's share, where that share was available. Build the packet around those three amounts. The second half of 2025, $4.726 billion, was larger than the estimated first half. Follow that order. Fierce's story flips it.
What is still open is everything the brief says it left out: administrative expense, payment changes on the larger share of out-of-network claims resolved before federal IDR, and any change in network contracting or negotiated rates. Fierce's Georgetown figure, $22 billion of IDR-associated costs in a study released in August, is a wider perimeter. Do not add it to $8.39 billion. Fierce's $8.02 billion is the same EBRI exercise with outlier awards pulled out, as Fierce reports it, and it is a floor on that exercise rather than a second study. The 85% win rate and the 2.6 million initiations are Fierce's context for how often this queue is used. They are not EBRI's $8.39 billion.
IDR awards, with the initial payment and the patient's share still in the sentence.
Sources: EBRI, Paul Fronstin, “The Federal Independent Dispute Resolution Process and Employment-Based Health Plan Costs,” November 12, 2026, 11 pages. The page states the study uses 2025 CMS federal IDR public-use data; $8.39 billion in additional health-plan payment obligations above initial payments after patient cost sharing; the method of selected award minus plan initial payment minus patient cost sharing where available; approximately 0.625% of an estimated $1.342 trillion in national employment-based health plan costs; about $46 per covered person per year, or $50 among people under 65; $4.726 billion in the second half of 2025; an estimated $3.662 billion in the first half; and the caveats that 0.625% is the scale of additional obligations set through federal IDR awards, not the overall effect of the No Surprises Act on premiums or spending, that administrative expenses are excluded, and that the figure does not capture payment changes for out-of-network claims resolved before federal IDR, changes in network contracting, or negotiated rates. Fierce Healthcare, Paige Minemyer, November 12, 2026, 1:45 p.m.: the Fronstin quotation, attributed by Fierce to the announcement; at least $8.02 billion after different outlier thresholds; providers won 85% of disputes last year; 2.6 million disputes initiated in 2025, set beside a federal estimate of about 22,000 cases a year reaching arbitration; a Georgetown University analysis released in August estimating $22 billion in total IDR-associated costs for 2025; about 63 cents per $100 as Fierce's rounding of the share; and Fierce's report that providers argue plans set low qualifying payment amounts in the opening negotiation. Fierce's article assigns the larger half-year amount to the first half. This article does not. The $22 billion, the 85%, the 2.6 million, and the $8.02 billion are not attributed to the EBRI page. The July 2, 2026 Zelis note is a separate RevCycleAI article and is not a result in this study. The RevCycleAI analysis section is our read.