New York was a national leader when it passed and enacted its No Surprises law. Long before federal protections existed, the state recognized a basic truth: patients should not be caught in the middle of payment disputes for medical care they could not reasonably avoid.
As a surgeon who provides emergency and complex hospital-based care in New York, I support that goal unequivocally. But current proposals to weaken the state’s Independent Dispute Resolution (IDR) process threaten to undermine the very protections the law was designed to provide and could ultimately reduce access to critical care for New Yorkers.
Supporters of these changes often frame the issue as a dispute over physician compensation. It is not. The real issue is whether New York will preserve a fair, independent system to resolve payment disagreements when insurers refuse to offer reasonable reimbursement for unavoidable, out-of-network care.
Why New York created IDR
New York’s No Surprises law was enacted in response to insurer practices that distorted the healthcare marketplace: artificially low payments, reliance on insurer-controlled data, and unilateral rate-setting that left physicians with little recourse. These practices threatened patient access, particularly for emergency and specialty services.
The state’s IDR process was designed as a safeguard. When negotiations fail, a neutral reviewer evaluates both sides’ offers using multiple factors written into law, including physician training, experience, and the complexity of care, rather than relying on a single insurer-determined benchmark.
Weakening this process would reverse one of the law’s most important protections.
The risk of overreliance on a single benchmark
At the center of the current debate is the Qualifying Payment Amount, or QPA, which is typically defined as the median in-network rate calculated by insurers.
The New York State Governor’s Executive Budget, particularly Part T of the Public Protection and General Government Budget Bill, proposes to “benchmark” physician payment rates. However, that would essentially cap IDRE payments at 50% or lower of the median payments to in-network providers (hired and owned by insurers).
Although this approach may appear objective, it often fails to reflect the realities of delivering complex medical care in New York. A median can be skewed downward when insurers include very low contracted rates, even from providers who rarely perform the service.
New York’s original law recognized this problem by requiring independent boards of arbitrators to consider multiple factors, not just insurer-derived data, when determining fair payment. In fact, the New York State NSA law was crafted because of the insurers’ vertical scheme and manipulation of data they, themselves generated; not for patient access, but for their own profits to hand down to shareholders.
Legal uncertainty, real consequences for New Yorkers
Courts have raised concerns about regulatory approaches that place too much weight on insurer-calculated benchmarks at the expense of statutory factors. Meanwhile, insurers have continued to rely on outdated methodologies while legal challenges proceed.
For independent physician practices and hospitals across New York, this uncertainty affects staffing, on-call coverage, and the ability to sustain specialized services patients rely on in emergencies. And when we look at those communities in need of high-quality healthcare, including those public sector workers, retirees, and those vulnerable populations who are enrolled in Medicaid managed care plans, removing the IDR would essentially remove their access to care.
Why arbitration use is high in New York
Some insurers, and the Governor’s budget office, point to arbitration volume as evidence the system is broken. A more likely explanation is that arbitration is often the only place physicians can obtain objective review after insurers offer payments far below reasonable market levels.
Over time, many commercial insurers have tied payments to Medicare rates, which have declined in real value. When private insurers anchor New York payments to those benchmarks while premiums rise for patients, pressure shifts to hospitals and specialists.
What arbitration decisions reveal
New York’s IDR process uses a neutral arbitration model requiring reviewers to select the more reasonable offer. When physicians prevail, it is often because insurer offers fall far below fair market value for the care provided. And again, highlights our history: the exact reason NSA and IDR and fair health methodologies were created in the first place.
Why this matters for patient access
If independent specialists cannot sustain their practices, care consolidates into larger systems, leading to narrower networks, less competition, and higher costs for New Yorkers.
The bottom line for New York
New York’s No Surprises law works because it balances patient protections with fair dispute resolution. Independent dispute resolution is not a loophole. It is the law’s safeguard. Weakening it risks reducing access to life-saving care.
Brian McHugh, MD, is an independent neuro and spine surgeon practicing in New York State.
