Physicians Are Winning in No Surprises Act Disputes, But Why Are Payers Not Paying?

October 28, 2026

What happens when physicians win No Surprises Act payment disputes, but insurers fail to pay? In this episode of Zotec Answers, Ed Gaines and Dr. Tilden Childs examine why unpaid IDR awards, disputed reimbursement calculations, and enforcement gaps continue to challenge physicians, independent medical practices, and the healthcare reimbursement system.

Why Winning No Surprises Act Disputes Doesn’t Guarantee Payment

Together, Ed and Dr. Childs examine the growing challenges surrounding the No Surprises Act (NSA), including unpaid Independent Dispute Resolution (IDR) awards, limited payment enforcement, and the financial consequences for independent physician practices. Dr. Childs shares his group’s experience winning 95% of federal IDR disputes while facing millions in unpaid awards. The conversation explores recent CMS audits revealing insurer noncompliance with qualifying payment amount (QPA) regulations, the potential impact of the Lower Premiums Faster Payments Act (H.R. 10788), and how the No Surprises Act Enforcement Act (H.R. 4710) could strengthen accountability. They also discuss why fair reimbursement, meaningful payer participation, and effective enforcement are essential to protecting independent medical practices and the future of patient care.

Key topics include:

• Why physicians are winning No Surprises Act IDR disputes but struggling to collect payments
• How unpaid arbitration awards are affecting radiology groups and independent physician practices
• Why the No Surprises Act’s 30-day payment requirement remains difficult to enforce
• What recent CMS audits reveal about insurer compliance with qualifying payment amount (QPA) regulations
• How the Lower Premiums Faster Payments Act (H.R. 10788) could change federal reimbursement and dispute resolution
• Why the No Surprises Act Enforcement Act (H.R. 4710) could strengthen payment accountability
• The importance of fair reimbursement, meaningful payer participation, and in-network negotiations
• How physician advocacy and federal healthcare policy influence the future of independent medicine

Ed and Dr. Childs also discuss the role of the Texas Medical Association’s lawsuits, the importance of physician engagement in healthcare legislation, and what stronger enforcement could mean for the long-term effectiveness of the No Surprises Act.

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About ZPAC: the Zotec Political Advocacy Committee (ZPAC), dedicates itself to making a difference for physicians and healthcare administrators nationwide. ZPAC advocates for equitable access to healthcare services for all individuals. Stay informed and engaged with ZPAC by following our podcast episodes, blog posts, and speaking engagements on our active Twitter/X and LinkedIn profiles. Together, we can shape policies that support healthcare providers and promote equitable access to quality care for all. To learn more about Zotec Partners, visit our website here.