Recent coverage of arbitration payouts misses the role of insurer lowball payment offers, network refusals, and high dispute-resolution default rates in driving costs for employers and patients
WASHINGTON, D.C., JULY 22, 2026. In response to recent Wall Street Journal coverage of surprise billing arbitration, the Emergency Department Practice Management Association (EDPMA) today called on health insurers to take responsibility for the practices driving up health care costs for employers and patients. The article’s framing around arbitration payouts overlooks a critical point: independent arbitrators, not providers, determine payment amounts, and those outcomes often reflect insurers’ initial underpayment strategies rather than provider overbilling. Emergency physicians say these dynamics are too often mischaracterized as a provider-side problem, when the evidence points the other way.
Emergency physicians report a consistent pattern: initial payment offers set well below fair market value, forcing providers into lengthy dispute processes just to be paid appropriately. Insurers routinely decline to negotiate reasonable network contracts, leaving patients out-of-network by the payer’s own choice, not the provider’s. Independent arbitrators, not providers, determine the payment amounts awarded through this process. And when disputes reach Federal Independent Dispute Resolution (IDR), some of the largest insurers default at rates far exceeding their peers, failing to respond or participate within required timeframes. The result is automatic losses that reflect administrative failure, not the merits of a claim.
UnitedHealth Group offers an instructive contrast. UHC actually engages with the Federal IDR process, and its default rate is among the lowest of any major payer, meaning its disputes are decided on the merits far more often than not. Yet UHC loses the substantial majority of those disputes on the merits, consistent with the fact that providers nationally prevail in roughly 80 to 85 percent of IDR determinations. Rather than accept that outcome as the process working as intended, UHC executives have repeatedly characterized the IDR process itself as “ineffective” and “exploited” on public earnings calls. Losing a fair fight is not evidence that the fight is rigged. It is evidence that initial payment offers were too low to begin with, which is precisely the problem IDR was designed to correct.
Layered on top of this are opaque fee arrangements, including so-called “shared savings” fees and rental network charges, that insurers apply to out-of-network claims. These arrangements extract additional revenue from the reimbursement process itself, often without clear disclosure to the employers footing the bill.
“These are not isolated incidents. They are structural choices made by payers, and they carry real costs, including administrative burden, delayed care coordination, and ultimately higher premiums passed on to the employers and patients insurers claim to be protecting,” said EDPMA Chair, William Freudenthal, MD. “Emergency physicians are committed to fair, transparent negotiation and network participation. It’s time insurers were held to the same standard.”
EDPMA urges regulators, employers, and the public to look closely at who is actually driving cost growth in the health care system. Emergency physicians continue to care for patients under the Emergency Medical Treatment and Labor Act (EMTALA) regardless of insurance status or network participation, an obligation that has never been matched by adequate or timely reimbursement. EDPMA looks forward to working with policymakers, regulators, and employers to ensure the true drivers of rising health care costs are addressed so that patients are not caught in the middle.
Media Contact: Matthew Clark, Executive Director, matt@edpma.org, Tel: +1.202.204.8400