LUGPA Policy Update: Pallone Introduces Legislation to Revise No Surprises Act Payment Disputes

October 2026

What Happened

On October 9, 2026, Rep. Frank Pallone (D-NJ), Ranking Member of the House Energy and Commerce Committee, announced the Lower Premiums, Faster Payments Act, legislation that would amend the No Surprises Act (NSA) by replacing its current independent dispute resolution (IDR) process with a payment system based on the median in-network rate.

The bill would also require payments to be issued within 30 days of a claim being filed. According to Pallone, the legislation is intended to address concerns that the current arbitration process has contributed to higher health insurance premiums, delayed payments, and administrative backlogs.

Pallone cited approximately 2.5 million disputes submitted in 2025, with roughly 67% filed by 10 provider groups. The announcement also cited an estimated $15 billion in provider awards during 2025. These figures reflect the sponsor’s rationale for the legislation and have not been independently evaluated here.

Why It Matters

The No Surprises Act, enacted in 2020, established federal protections against certain surprise out-of-network medical bills and created the IDR process to resolve payment disputes between providers and health plans. The process allows eligible providers and insurers to seek independent determination when they cannot agree on payment.

Replacing IDR with a system based on the median in-network rate could significantly change how out-of-network payment disputes are resolved. A benchmark-based approach may limit the role of independent arbitration in determining payment amounts, potentially affecting reimbursement for services covered by the law.

How It Could Affect LUGPA Members

Out-of-network reimbursement: Urology practices that provide services subject to the NSA could see changes in how disputed claims are paid, depending on the bill’s final benchmark methodology and implementation.
Payment timelines and cash flow: The proposed 30-day payment requirement could provide greater predictability for eligible claims, although the practical effect would depend on how the requirement is defined and enforced.
Administrative workload: Replacing the existing IDR process could change the time and resources practices devote to payment disputes, documentation, and reimbursement follow-up.
Independent practice sustainability: Any changes to dispute resolution and reimbursement could affect the financial viability of practices that rely on appropriate payment for out-of-network services. The impact would depend on the final legislation and the services affected.

Next Steps

The Lower Premiums, Faster Payments Act has been introduced, but its prospects for congressional consideration and enactment remain uncertain. LUGPA members should monitor legislative developments and assess whether proposed changes could affect their out-of-network billing and reimbursement practices.

LUGPA will continue to monitor federal policy developments affecting physician reimbursement, patient access, and the sustainability of independent urology practices.

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