Frequently asked questions
Separating myths from facts.
The basics
Getting oriented
MPSA is a new national coalition bringing together leading providers of revenue cycle, legal representation, and other vital medical practice support services. We are dedicated to securing fair, transparent, and sustainable reimbursement for medical practices and the full and faithful implementation of the No Surprises Act.
The No Surprises Act is a federal law, in effect since 2022, that was passed to protect patients from surprise medical bills and strengthen their access to in-network care. It removes patients from payment disputes between providers and insurers and routes those disputes to an unbiased independent resolution process.
IDR is the NSA's arbitration process. When a provider and an insurer can't agree on payment for out-of-network care, a neutral, certified IDR entity reviews each side's offer and selects one. It follows a required Open Negotiation period and is meant to be a balanced backstop, keeping patients out of the middle.
The QPA is supposed to be the insurer's median in-network contracted rate for a service in a geographic area, and it serves as a key benchmark in the IDR process. When insurers set QPAs artificially low, providers are systematically underpaid, a central concern in the disputes MPSA's members see every day.
Anyone who shares our dedication to supporting clinicians and medical groups as they face abusive action by health insurance companies. If that's your organization, we'd like to hear from you. Get involved →
Myths vs. documented facts
Big Insurance makes a series of claims about providers. The facts are not with them.
Their inaccurate statements appear to serve one purpose: continued profiteering and manipulation of the No Surprises Act's safeguards. Here's what the evidence actually shows.
Documented fact
An estimated 3 billion health insurance claims were filed in 2023. By contrast, only 2.4 million claims entered IDR arbitration in 2024, equal to just 0.08% of total health claims. A number that small is not a "flood" or "gaming," nor the reason premiums have risen to an average of roughly $27,000 per year for families.
Documented fact
Less than 1% of all healthcare claims go to IDR. Out-of-pocket costs are actually down 18%, family spending fell an average of $567, from $3,674 to $2,922. Meanwhile family premiums rose to nearly $27,000 ($26,993 in 2025, up 26% over five years).
Insurers collect more than $1.5 trillion annually in premiums, nearly 700× the $2.24 billion value of all IDR awards in 2024. Insurance executive compensation has risen 20%+ since 2023.
Documented fact
Americans for Fair Health Care (AFHC) national surveys show insurers are consistently non-compliant. They routinely shift protected costs to patients, fail to pay arbitration bills within the 30-day requirement, don't pay a fifth of IDR-awarded payments at all, set QPAs well below median in-market rates, and exclude available remark codes, imposing thousands of administrative hours and crushing losses on providers.
Documented fact
Payers typically benchmark IDR offers to the QPA, but AFHC's analysis exposes QPA manipulation that underpays providers. In 65% of IDR disputes, the reported QPA was lower than the true median in-network amount, with actual in-network rates averaging 300% higher than reported QPAs. Insurers have set thousands of QPAs at absurd values, as little as $0.01 and $0.00.
Documented fact
IDR entities side with providers 80%+ of the time for two simple reasons: insurers routinely underpay, and they often fail to show up. In a review of Q2 2025 disputes the insurer lost, the insurer lost by default, making no offer at all, in 27% of cases, and offered less than $1 in another 9%. Almost 40% of the time, the provider prevailed because the insurer didn't even try to defend its rate.
Documented fact
National survey data reveal providers are being forced out of networks, not voluntarily leaving. Nearly one-quarter of providers have had contracts unilaterally terminated by insurers, who pass enormous costs onto self-insured employers through a mechanism cynically called "shared savings." The result is nationwide network contraction, limiting access to care, especially in rural communities, and raising costs for employers.
Documented fact
In April 2026 alone, the U.S. District Court for the Central District of California dismissed every claim brought by Anthem Blue Cross; the Middle District of Florida threw out Aetna's lawsuit; and the Eastern District of Pennsylvania shut down United's attempt, noting that just because an insurer dislikes the way Congress mandated the dispute-resolution protocol, lawsuits are not the remedy.
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