No Surprise, Surprise: New Insurer Study Blames Doctors

If you have seen headlines claiming that the No Surprises Act is “driving up healthcare costs,” you may have seen a new study co-authored by Elevance Health Public Policy Institute—the same Elevance that is one of the country’s largest insurers.

The study argues that payments decided through arbitration—the process Congress created to resolve disputes between insurers and doctors—are wildly “inflationary,” often several times higher than what insurers say is the market rate.

It sounds alarming—it is also deeply misleading.

Here is the problem in plain English: the study relies on a benchmark called the qualifying payment amount, or QPA. And the QPA often is not what insurers say it is.

What Is the QPA—and Why It Matters

Under the No Surprises Act, patients are protected from surprise medical bills when they receive emergency care or care they couldn’t reasonably choose. Insurers and providers are supposed to negotiate payment behind the scenes. If they can’t agree, an independent arbitrator decides.

To guide that decision, insurers provide a number called the QPA—supposedly the median in-network rate they pay doctors for the same service in the same area.

In theory, that sounds fair.

In practice, the QPA is calculated by insurers, reported by insurers, and—critically—rarely audited.

The Study’s Own Data Undercuts Its Conclusion

Here is the part the headlines gloss over: even in the Elevance-promoted study, the QPA often does not match real in-network prices.

In many cases, the study shows that the QPA is lower than what insurers actually pay doctors who are in-network.

That matters because the entire argument that arbitration is “inflationary” rests on comparing arbitration outcomes to QPA.

If the benchmark is artificially low, then anything compared to it will look inflated.

That is not evidence of a broken law. It is evidence of a broken measuring stick.

What the Study Compares—and Why It’s a Problem

Instead of comparing QPAs to actual negotiated contract rates, the study compares them to paid claims—what insurers ended up paying after billing edits, utilization rules, and internal processing.

That is not the same thing as a negotiated price. It is like judging the cost of a car by looking at a discounted receipt rather than the sticker price.

The study also blends together large geographic areas and focuses on a tiny slice of cases—only those that went to arbitration, which represent a small fraction of all claims under the law.

In other words, it zooms in on the most contentious cases, then presents them as proof of a system-wide problem.

Who Benefits From This Narrative?

Elevance has a significant financial and legal interest in promoting the idea that arbitration awards are excessive.

Insurers across the country are facing lawsuits and regulatory scrutiny over how they calculate QPAs. Some federal audits have already found insurers miscalculating them.

Framing arbitration as the villain shifts attention away from a simpler question: are insurers accurately reporting the prices they already pay doctors?

If QPAs were transparent, audited, and aligned with real market rates, far fewer disputes would ever reach arbitration in the first place.

The Bottom Line

The No Surprises Act was designed to protect patients—not to guarantee insurers the lowest possible price.

Calling arbitration “inflationary” without first ensuring that QPAs reflect reality is like blaming the thermometer when the room feels cold.

Before policymakers rush to weaken patient protections, they should ask a more basic question: are insurers playing fair with the numbers they control? 

Because if the benchmark is wrong, the conclusions will be too.