Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-New Jersey) has opened a new oversight push into the No Surprises Act’s arbitration system, sending letters on Thursday to six independent dispute resolution entities. The requests went to C2C Innovative Solutions, Commence, Dane Street, EdiPhy Advisors, National Medical Reviews and ProPeer Resources.

The letters ask for more information on how the companies are complying with the No Surprises Act, which shields patients from surprise medical bills by requiring insurers and providers to attempt 30 days of negotiations before either side can move a payment dispute into the IDR process. In that process, a neutral arbitrator selects one of the parties’ payment offers.

Why The Process Is Under Scrutiny

Pallone’s intervention reflects a widening gap between how Congress expected the system to work and how heavily it is now being used. The process was initially estimated at about 17,000 disputes annually, but 2.5 million disputes were filed in 2025, according to his announcement. Pallone’s office also said most cases appear to be initiated by a small group of private equity-backed providers.

The payment outcomes are another pressure point. According to the announcement, IDR entities awarded about $15 billion in payments to providers in 2025, and providers won more than 85% of determinations at amounts more than six times local in-network rates. That combination has fed criticism that the arbitration system may be pushing costs back into premiums and out-of-pocket spending rather than simply resolving billing disagreements.

What Pallone Wants

In the letters, Pallone said the law has protected millions of families from surprise medical bills but added that he is concerned the IDR process “is not functioning as Congress intended and is resulting in increased out-of-pocket costs and higher premiums for consumers.” He also said he is concerned that “some corporate entities are using aggressive tactics to undermine the No Surprises Act” and that his staff has repeatedly requested information about company processes and procedures pertaining to NSA arbitration without receiving a substantive response.

Pallone asked each company to provide information by September 24. The broader signal is that oversight is moving beyond the text of the No Surprises Act itself and toward the conduct of the entities administering disputes, a shift that could matter if lawmakers decide that implementation, not just volume, is distorting the market.