IDR Payment & Enforcement

New York Times examines unpaid IDR awards and the enforcement debate

Source: The New York Times · Margot Sanger-Katz and Sarah Kliff · November 3, 2026

Summary published November 3, 2026

A New York Times investigation reports substantial unpaid awards in a billing firm’s tracked cases, alongside insurer objections and competing reform proposals.

What did the investigation find?

Reporting by Margot Sanger-Katz and Sarah Kliff describes providers struggling to collect payments after winning No Surprises Act arbitration. The Times reviewed HaloMD data covering 409,102 cases from January 2024 through July 2026 in which payments could be reliably tracked. Nearly 30 percent of awards in that dataset remained unpaid; Anthem’s reported share was 74 percent.

These figures describe HaloMD’s tracked cases, not a representative national sample of every federal IDR award. The article says the dataset covers roughly two-thirds of the firm’s wins since 2024. Cigna disputed the reported extent of its nonpayment in 2026.

Why are insurers withholding payments?

Several insurers told the Times they withhold payment when they believe a claim was ineligible for arbitration, even after an arbitrator found otherwise. Insurers also criticized high awards and alleged improper submissions. Providers and billing firms disputed those positions. The article reports that a CMS spokesperson said insurers must pay arbitration awards.

How are providers affected?

The report describes cash-flow pressure on emergency practices and air ambulance operators. Wake Emergency Physicians reported $1.2 million in outstanding awards and said it borrowed to meet payroll. Flight for Life reported $2.1 million owed by Anthem; Anthem challenged the claims’ procedural eligibility, which Flight for Life disputed.

What is happening on enforcement?

The Times reports a Labor Department investigation into Anthem’s nonpayment and says Anthem is cooperating. It also describes legal obstacles to private enforcement lawsuits and competing congressional approaches: stronger nonpayment penalties or replacing arbitration with a payment benchmark. These are reported developments and proposals, not a guarantee of collection or an enacted replacement of IDR.

Our takeaway: track payment after the determination

An award and a collected payment are separate milestones. Keep eligibility documentation, determination notices, payment records, and follow-up activity together so outstanding balances can be reviewed and escalated with a clear record.

Related reading: Enforce or replace IDR? Two approaches to No Surprises Act reform.