HHS Adds a 17th Certified Arbiter to Handle Surprise Billing Disputes

The U.S. Department of Health and Human Services has certified Physio Solutions, doing business as medlitix, as the 17th independent dispute resolution (IDR) entity authorized to settle out-of-network payment disputes under the No Surprises Act, according to Healthcare Dive, which reported the addition on September 15, 2026. The No Surprises Act is a federal law, effective January 2022, that limits how much patients with employer, marketplace, or other commercial health coverage can be billed when they receive certain out-of-network care, such as emergency treatment or services from an out-of-network provider at an in-network facility. An IDR entity is a certified arbiter, separate from HHS, that reviews disputed claims when an insurer and a provider cannot agree on payment and issues a binding decision on the amount owed.

The addition of medlitix comes as the federal IDR process faces a rising caseload. Healthcare Dive reports that arbiters in this system are drawing increasing scrutiny from researchers and lawmakers, though the source material does not detail the specific findings or legislative proposals driving that scrutiny. HHS has not stated that medlitix or any existing arbiter has done anything improper; the certification is a routine expansion of processing capacity, not a response to a finding of wrongdoing by any specific entity.

Why the Dispute Volume Matters for Coverage Costs

A growing IDR caseload is a signal of how often providers and insurers disagree on out-of-network payment, and that disagreement can eventually show up in premiums and plan design. When more disputes go to arbitration, insurers and providers spend more on administrative and legal costs tied to resolving them, and those costs are typically factored into future contract negotiations and plan pricing. Healthcare Dive's reporting frames the new certification as a direct response to surging dispute volume, which suggests the existing 16 certified entities were reaching capacity limits.

For most people under 65 with employer-sponsored or marketplace coverage, the practical protection has not changed: the No Surprises Act still caps what patients owe for covered out-of-network emergency care and certain non-emergency services, and any payment dispute between the provider and insurer is supposed to be resolved through IDR rather than passed on to the patient as a surprise bill. The certification of a new arbiter is an operational change to how quickly and by whom those disputes get resolved, not a change to patient billing protections themselves.

Key Takeaway

The No Surprises Act primarily protects people with employer, marketplace, or other commercial health coverage, not Original Medicare or most Medicare Advantage enrollees, who already have separate balance-billing protections under existing Medicare rules. This news is most relevant to readers who are still working and covered by an employer plan before Medicare eligibility, or who manage billing questions for a spouse or family member on commercial insurance.

What This Means for Medicare-Age Readers and Their Families

If you are already enrolled in Original Medicare, federal rules that predate the No Surprises Act already limit what most providers can charge you, and those protections do not run through the IDR arbitration process described in this news. If you are enrolled in a Medicare Advantage plan, CMS network and billing rules, not the No Surprises Act's IDR system, govern how out-of-network disputes between your plan and a provider are typically handled. That distinction matters because it means a rising IDR caseload in the commercial market does not directly translate into new billing risk for most Medicare beneficiaries.

Where this news is directly relevant: readers who are 65 or older but still working and covered by an employer group health plan, retirees on a former employer's retiree health plan that functions like commercial coverage, or family members, such as an adult child or spouse, who carry marketplace or job-based insurance. For those situations, the practical takeaway is unchanged by this specific certification but worth restating: if you receive a bill you believe violates No Surprises Act protections, you can dispute it directly with your provider or insurer, and you do not need to understand the IDR arbitration process to exercise that right, since disputes over the correct payment amount are handled between the provider and insurer, not billed to you while pending.

For anyone approaching a Medicare enrollment decision, this is also a reminder to ask a licensed insurance agent or broker how a specific plan, whether Original Medicare with a supplement, or a Medicare Advantage plan, handles out-of-network emergency care and balance billing, since the rules differ from the commercial-insurance framework this HHS certification affects. Comparing that protection alongside premiums, provider networks, and drug coverage remains one of the more overlooked steps in choosing a plan during Medicare's annual enrollment period.