The No Surprises Act took effect on January 1, 2022 with a clear mandate: stop patients from being blindsided by bills from out-of-network providers at in-network facilities. It largely worked. Patients are no longer the ones caught between a hospital and an insurer arguing over who pays.
What nobody fully anticipated was the machine that would grow up around the dispute resolution system meant to settle those arguments. Four years later, that machine has processed 2.5 million disputes in a single year, awarded providers roughly $15 billion in a single year, and generated $22.4 billion in total system costs since 2022. On October 8, 2026, Rep. Frank Pallone Jr. of New Jersey, one of the law's original authors, introduced the Lower Premiums, Faster Payments Act, which would replace the arbitration system with a price benchmark tied to 2019 contracted rates.
This article covers what the bill does, what the data says, who is fighting it, what is already changing, and what operators need to…
