How the Independent Dispute Resolution Process Helps Anesthesia Groups Regain Financial Control
Independent anesthesia groups, particularly small to midsize practices, have long struggled to secure fair reimbursement rates from powerful insurance companies. These anesthesia groups are often overlooked during contract negotiations, leaving providers with limited leverage, resulting in frequent underpayment for anesthesia services. However, the Independent Dispute Resolution (IDR) process, introduced through the No Surprises Act, offers these groups a powerful mechanism to dispute inadequate payments and seek appropriate compensation.
Recent reforms like the Transparency in Coverage Act also work in their favor, requiring insurers to publicly disclose payment rates. This data, once unavailable, now helps anesthesia providers, vendors, and consultants better understand the market and negotiate from a stronger position. With added support from vendors, such as BillWell, who specialize in navigating the IDR process, these groups are reclaiming leverage and achieving fairer reimbursement rates.
What Is the IDR Process?
The Independent Dispute Resolution (IDR) process provides a third-party arbitration option when providers and insurers can’t agree on reimbursement for out-of-network services.
Small and midsize anesthesia groups have begun to leverage the IDR process to challenge low offers from insurers. IDR filings increased fivefold in 2023, with providers winning the majority of cases:
Q1 2023: 72% of resolved disputes favored providers
Q4 2023: That figure rose to nearly 85%
“These outcomes speak for themselves—IDR works. It’s helping anesthesia providers push back against unsustainable payer behavior and, importantly, reduce—or in some cases, completely eliminate—subsidy requirements for their facility clients,” said Stacy Dawson, Director of Business Development at Phoenix, AZ-based BillWell.
Despite this success, only an estimated 5%-15% of eligible out-of-network claims are currently being submitted through the IDR process. This low usage allows insurers to continue reimbursing just 50-60% of the true anesthesia cost, limiting the overall effectiveness of the system. Broader participation and stricter enforcement are necessary to change insurer behavior and promote fairer compensation.
Understanding the Fees Associated with the IDR Process
While effective, the IDR process does involve certain administrative and arbitration costs—a critical factor for small to midsize anesthesia groups to consider.
Administrative Fees for initiating the IDR process:
- 2023: $50 per party
- 2024-2025: $115 per party
Certified IDR Entity Fees vary based on the complexity and nature of the dispute:
- Single Determinations (2025): $200 to $840
- Batched Determinations (2 to 25 line items): $268 to $1,173
- Over 25 line items: Tiered structure with $75 to $250 for every additional 25 line items
Typically, the losing party is responsible for covering these costs. If both parties reach an agreement before the arbitrator makes a decision, the fees are split.
What’s Next
New Legislation like H.R. 9572 – The “Protecting Patients from Surprise Medical Bills Act of 2025” (H.R. 9572), introduced by Rep. Greg Murphy, proposes significant penalties for insurers who delay payments after losing an IDR case. Under this legislation, fines could reach up to three times the disputed amount.
Anesthesia groups can support the bill by advocating for stronger enforcement of payment timelines and raising awareness about the benefits of these provisions for smaller practices. Supporting the bill would help ensure that insurance companies are held accountable, promoting timely reimbursements and making the IDR process more accessible to smaller providers.
Predicting the Future: Comparing the path of IDR Vendors to Homeowners Insurance Claims and Adjusters
A helpful way to understand the impact of the IDR process is by comparing it to how homeowners insurance disputes are handled. In states like Florida, insurers often settle quickly to avoid costly legal fees associated with drawn-out cases. Similarly, as arbitration costs rise under the IDR process, insurance companies may become more willing to settle at fairer rates to avoid additional financial burden.
Just as homeowners rely on independent adjusters, anesthesia groups can turn to specialized IDR vendors for support. These vendors assist with preparing claims, presenting documentation, and navigating arbitration effectively. For smaller practices, this type of guidance can significantly improve outcomes—helping them negotiate more successfully and secure appropriate reimbursement for their anesthesia services.
Leveraging the IDR Process for Greater Stability
The IDR process presents a critical opportunity for small to midsize independent anesthesia groups to reclaim control from insurance companies and receive fair reimbursement. While fees may pose challenges, the potential for improved financial outcomes—especially when paired with expert support from anesthesia consultants and vendors—makes it a worthwhile endeavor.
As the political landscape continues to move in our favor, now is the time for anesthesia groups to act. By embracing the IDR process and partnering with the right experts, independent practices can reduce subsidy burdens, stabilize cash flow, and take back control of their financial future.
To learn more about how your group could benefit from IDR, please contact us to see how we can improve your practice’s financial performance.
Contributors:
Stacy Dawson
Director, Business Development BillWell
Phone: 972-415-2556
E-mail: sdawson@billwell.net