Here's what the bill does, how it could affect you, and what to do now.
What is happening?
Under the No Surprises Act, when an insurer underpays an out-of-network bill, providers can take the dispute to an independent arbitrator. This process is called IDR (independent dispute resolution), and many providers win these cases.
In October 2026, Rep. Frank Pallone introduced the Lower Premiums, Faster Payments Act. Starting in 2028, it would:
- End arbitration for out-of-network disputes
- Pay a fixed rate based on what insurers paid in-network in 2019, adjusted for inflation
- Require insurers to pay within 30 days
How this could affect your practice
Today: nothing changes. This is only a proposal and isn't law. Experts say its chances in the near term are low.
If it passed, out-of-network practices would lose the right to fight low payments. Payments would likely drop for emergency, anesthesia, radiology and other specialties that often work out of network.
The one upside: the 30-day payment deadline would speed up cash flow.
What to do now: 5 simple steps
How to turn this into an opportunity
Negotiate early.
Practices that start contract talks now will negotiate from a stronger position than those who wait.
Faster payment.
If a version passes, the 30-day rule would help cash flow.
Key dates
| Date | What happens |
|---|---|
| Now | Arbitration (IDR) still available. Keep using it. |
| December 11, 2026 | Government funding deadline; a smaller change could be attached |
| January 1, 2028 | Proposed start date if the bill passed |
The bottom line
Nothing changes yet. But if you depend on out-of-network income, review your numbers and contracts now, and watch the December funding deal.
Frequently asked questions
What is IDR under the No Surprises Act?
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IDR (independent dispute resolution) is a process where an independent arbitrator decides the payment when a provider and an insurer disagree about an out-of-network bill.
Is the bill to end arbitration law?
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No. It is only a proposal. It would need to pass Congress and be signed into law, and experts say its near-term chances are low.
What is the QPA?
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The QPA (qualifying payment amount) is roughly the insurer's typical in-network rate for a service. The bill would make a 2019-based version of it the payment rate.
What should out-of-network practices do now?
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Know how much revenue depends on out-of-network payments, keep using arbitration, and consider whether in-network contracts make sense for you.
Feeling overwhelmed? HealthRescue Partners can help
If you're not sure how this could affect your income, HealthRescue Partners can help. We can:
- Explain the bill and the IDR process in plain terms
- Help you understand how much of your revenue is at risk
- Guide your next steps on contracts and payments
Sources
- Rep. Pallone proposes replacement of No Surprises Act arbitrationHolland & Knight, Oct 9, 2026
- Pallone's proposal to end IDR arbitration could face near-term challengesThe Capitol Forum
This article is general information, not legal or billing advice.