No Surprises Act Defense for Self-Funded Health Plans
The No Surprises Act protects patients from surprise bills, and it does that well. But it also created a federal arbitration process called Independent Dispute Resolution (IDR) that providers are using aggressively to push for payments far above what the plan originally paid.
For self-funded health plans and their plan sponsors, unmanaged IDR exposure is a real financial risk. aequum handles eligibility review, open negotiation, and IDR arbitration defense so your plan pays only what it should.
The NSA Protects Members. The IDR Process Is a Different Story.
The No Surprises Act does two distinct things. It protects patients from being balance-billed for certain out-of-network services, and that protection works well.
It also created the Independent Dispute Resolution (IDR) process, which providers use to dispute what health plans paid. In IDR, an IDR entity chooses between the plan's offer and the provider's offer. Providers win the majority of these disputes and frequently collect amounts far above the qualifying payment amount (QPA) and median in-network rates. Most plan sponsors don't know this is happening until they're already in the middle of it.
What the NSA Protects Members From
- Out-of-network charges for emergency services
- Out-of-network provider charges, mainly physician charges, at in-network facilities
- Excessive air ambulance charges
- Unapproved notice-and-consent attempts by providers
What It Created for Health Plans
- A federal IDR arbitration process providers use to demand higher payments
- Strict deadlines that require fast, organized responses
- Fragmentation tactics: providers splitting one encounter into multiple disputes to multiply fees
- Fiduciary risk for plan sponsors without proper documentation
What to Do When You Receive an Open Negotiation Notice
An Open Negotiation Notice is the formal document a provider sends to start the NSA dispute process. Most plan sponsors who receive one for the first time don't know what it means, what it triggers, or how much time they have to respond.
The Clock Starts Immediately
The notice triggers a 30-business-day open negotiation window. Strict deadlines apply from the moment it arrives. Missing them limits your options significantly.
IDR Can Follow Within Days
If the dispute isn't resolved during the negotiation window, either party can initiate IDR. That filing must happen within 4 business days of the negotiation period ending.
The Plan Must Respond Quickly
Once a provider initiates the process, the health plan must evaluate eligibility issues, engage in negotiation, and be ready to select an IDR entity if the dispute proceeds.
Early Involvement Changes the Outcome
The earlier aequum is involved, the more options the plan has. We manage the entire open negotiation period, build a documented record, and make sure no deadline gets missed.
Don't wait to see what happens. The process has firm deadlines and the provider is already moving. We step in immediately, handle all communications, and protect the plan's position from day one.
Where NSA Exposure Actually Shows Up
Employer plans were involved in over 524,000 IDR disputes in a single quarter of 2025, a 119% increase year over year. When self-funded plans lose these disputes, they pay an average of 23 times the qualifying payment amount. NSA exposure is not a theoretical risk. Here's where it shows up and what aequum does about it.
NSA disputes are being treated as unavoidable costs, with no review of whether they actually qualify under the law. Plans are paying to defend cases that never should have reached IDR.
We review every dispute for NSA eligibility first. Identifying ineligible cases saves the plan money before arbitration even starts.
Arbitration awards keep rising because IDR submissions are inconsistent, poorly documented, or not aligned with the plan's pricing logic.
We build IDR submissions with strong documentation, consistent legal arguments, and pricing logic tied directly to the plan's position. Consistency across cases strengthens outcomes over time.
Providers are splitting one patient encounter into multiple separate IDR disputes to multiply their filing fees and potential awards.
We identify and challenge dispute fragmentation early, raising unbundling defenses before the arbitration process advances.
HR teams and TPAs are overwhelmed managing IDR notices, strict deadlines, and provider communication on top of their regular workload.
We handle the entire process: notices, timelines, submissions, provider communication, and documentation. Internal teams don't have to touch it once we receive the necessary documentation.
Plan sponsors face fiduciary exposure without clear reporting or documentation showing how NSA disputes are being managed and resolved.
We provide full, audit-ready reporting on every dispute, giving plan sponsors the documentation they need to demonstrate sound fiduciary oversight.
How aequum Manages an NSA/IDR Dispute
→
Eligibility Review
We check whether the dispute actually qualifies under the NSA. Many IDR filings are ineligible. Catching those early saves the plan money before arbitration starts.
→
Open Negotiation
We manage the required 30-day negotiation period on your behalf, building a documented record that supports the plan's position if the case proceeds to IDR.
→
IDR Defense
We prepare and submit the plan's full IDR case: payment offer, supporting documentation, pricing rationale, legal arguments, and any applicable defenses.
Post-Award Advocacy
When an award goes against the plan, we review the decision for potential errors and advise on the available options for further action.
Who We Work With on NSA Defense
The No Surprises Act IDR process affects self-funded plans differently depending on claim volume, plan design, and pricing structure. Here's who we work with most often.
Self-Funded Health Plans
Plans facing IDR filings from out-of-network providers and looking for consistent, well-documented defense.
Third-Party Administrators (TPAs)
TPAs that need NSA compliance and IDR support across a broad book of self-funded clients.
Reference-Based Pricing Plans
Reference-based pricing plans that want to understand how their pricing structure interacts with the NSA's IDR process and how to use that interaction to reduce or eliminate arbitration exposure entirely.
Employers & Plan Sponsors
Plan sponsors who want clear documentation and audit-ready reporting to support fiduciary oversight of NSA dispute handling.
What Partners Have Seen
Their success rate with balance billing issues presented to them has been in excess of 99% by any standard of measurement… They have been shown to be the most effective solution to the only real impediment to adopting reference based pricing.
We've been working with aequum for over 3 years and couldn't be happier. Their knowledge and advice has been invaluable to us as a Third Party Administrator.
Aequum's expertise in balance billing disputes and IDR proceedings strengthens the foundation of the pricing solutions we deliver at ClaimsBridge. A trusted and highly valued partner in the self-insured market.
Frequently Asked Questions
Useful Reading on the No Surprises Act
What to Do When You Receive an Open Negotiation Notice
A plain-language guide for self-funded employers and plan administrators on what the Open Negotiation Notice means, what deadlines it triggers, and how to respond.
Learn More →IDR Dispute Volumes Are Surging: What Self-Funded Plans Need to Know in 2026
CMS data shows employer plans faced over 524,000 IDR disputes in a single quarter of 2025, a 119% increase year over year. What that means for your plan and what to do about it.
Learn More →How Private-Equity Emergency Providers Are Using IDR Against Health Plans
A small number of private-equity-owned emergency groups are responsible for a disproportionate share of IDR filings. What plan sponsors need to know about the pattern and how to defend against it.
Learn More →Received an Open Negotiation Notice or Facing an IDR Dispute?
The NSA dispute process has strict deadlines. The earlier we're involved, the more options the plan has. If you have an active situation or just want to understand your exposure, our team is straightforward to reach.