Arbitrator Profits Rise Under No Surprises Act Rules

Employers and insurers face rising costs as arbitration volume increases, potentially impacting future healthcare premiums.

Updated on Oct. 21, 2026 in Healthcare

Bold flat-color editorial illustration showing balanced industrial scales and geometric blocks, representing the financial weight of healthcare payment disputes. — Arbitrators under the No Surprises Act face tightening oversight as soaring dispute volumes and rising administrative costs impact healthcare premiums. AI Illustration. Upload story photo >

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Nonprofit arbitrator iMPROve Health achieved a 70% profit margin by 2025, fueled by a 13-fold increase in revenue since 2022. The surge highlights the financial outcomes for organizations managing the high volume of payment disputes under the No Surprises Act.

Why it matters

Arbitrators have seen earnings rise as the volume of payment disputes between providers and insurers skyrocketed, leading federal regulators to intervene. These arbitration costs are ultimately borne by employers and insurers, who may pass expenses to households through premiums.

iMPROve Health reported a 70% profit margin in 2025 following a 13-fold revenue increase, contrasting with a $2 million loss in 2022. During the first half of 2025, 1.2 million new disputes were filed, with four large provider groups accounting for 56% of that volume.

The players

iMPROve Health

A Michigan-based nonprofit arbitration firm that manages payment disputes between medical providers and insurers.

CMS

The federal agency overseeing the implementation and dispute resolution processes of the No Surprises Act.

The details

Arbitrators operate by selecting one party’s offer in payment disputes, with the losing side mandated to pay the arbitrator’s fee. To capitalize on the dispute volume, iMPROve Health transitioned to a fully remote model and streamlined its budget following initial losses. Federal regulators have since tightened oversight, recently dropping administrative fees to $15 per party as of June 2026 to curb system costs.

2022: iMPROve Health incurred a $2 million loss.
April 2022: Federal system began closing medical payment disputes.
2023: Federal rule established an administrative fee of $115 per party.
June 11, 2026: Administrative fee was reduced to $15 per party.
October 1, 2026: CMS officials met with certified arbitrators to address system costs.

Market Landscape

The rise of iMPROve Health profit margins follows the implementation of the No Surprises Act. This development highlights the unintended financial outcomes for entities tasked with mediating the high volume of disputes generated by federal healthcare billing reforms.

Operators should anticipate that administrative costs for medical billing disputes will remain a focal point for CMS regulatory adjustments. Businesses should review their insurance premiums, as insurers and employers are increasingly passing the costs of high-volume arbitration down to the plan level.

The takeaway

The concentration of disputes among a small number of large provider groups suggests that arbitration outcomes are significantly influenced by specialized filing strategies. Operators should monitor their own provider contracts to evaluate whether their billing dispute costs align with these industry-wide averages.