<div class="css-s99gbd StoryBodyCompanionColumn" data-testid="companionColumn-0"><div class="css-53u6y8"><p class="css-ac37hb evys1bk0">Dr. Norman Rowe, a plastic surgeon with offices in New York and Florida, <a class="css-yywogo" href="https://normanrowemd.com/procedures/breast/breast-reduction-nj/" rel="noopener noreferrer" target="_blank" title="">advertises on his website</a> that breast reduction surgery usually costs between $15,000 and $25,000.</p><p class="css-ac37hb evys1bk0">But these days, his practice sometimes earns $440,000 for the procedure.</p><p class="css-ac37hb evys1bk0">Dr. Rowe has taken full advantage of a new arbitration system, part of a major consumer protection law Congress passed in 2020 with <a class="css-yywogo" href="https://www.nytimes.com/2020/12/20/upshot/surprise-medical-bills-congress-ban.html" title="">bipartisan majorities</a>. The No Surprises Act was designed to eliminate surprise medical bills, for patients who showed up in the emergency room and were treated by a doctor who didn’t take their insurance.</p><p class="css-ac37hb evys1bk0">It bars those out-of-network doctors from billing patients directly. Instead, they can plead their case to a government-approved arbitrator. If they win, the patient’s insurer has to pay their desired amount.</p><p class="css-ac37hb evys1bk0">By all accounts, the law is successfully protecting patients against bills from doctors they never chose. But it has also generated an expensive unanticipated consequence: Doctors have flooded the arbitration system with millions of claims. Most are winning, often collecting fees <a class="css-yywogo" href="https://www.brookings.edu/articles/no-surprises-act-arbitration-databook/" rel="noopener noreferrer" target="_blank" title="">hundreds</a> of times higher than what they could negotiate with insurers directly or what they could have earned from patients before the law passed.</p></div><aside aria-label="companion column" class="css-ew4tgv"></aside></div><div data-testid="Dropzone-1"></div><div class="css-s99gbd StoryBodyCompanionColumn" data-testid="companionColumn-1"><div class="css-53u6y8"><p class="css-ac37hb evys1bk0">“I’m still glad we passed the bill, because we got consumers out of it, but we need to rein in this arbitration process,” said Representative Frank Pallone Jr., Democrat of New Jersey, who helped negotiate the law.</p><p class="css-ac37hb evys1bk0">Some health plans said they have increased premiums this year to cover the extra costs. The United Service Workers health plan, which covers 20,000 trades workers in the New York area, said it boosted premiums by an extra 1.75 percentage points to offset arbitration awards and fees. The system has also enriched a new class of <a class="css-yywogo" href="https://www.statnews.com/2026/03/18/no-surprises-act-loophole-profits-scott-laroque-mpowerhealth-alla-laroque-halomd/" rel="noopener noreferrer" target="_blank" title="">specialized businesses</a>, which assist doctors in navigating the bureaucratic process.</p></div><aside aria-label="companion column" class="css-ew4tgv"></aside></div><div data-testid="InteractiveBlock-3"><section class="interactive-content interactive-size-scoop css-kqcwdy" data-id="100000010852318" data-source-id="100000010852318" data-testid="inline-interactive" data-uri="nyt://embeddedinteractive/f07f06f6-7711-586a-b2be-b6eb8948199b" id="datawrapper_B8Fa2"><header class="css-obecq5 interactive-header" id="interactive-header"><h2 class="css-4hk76s interactive-headline" id="interactive-headline">The Number of Disputes in Arbitration Has Exploded</h2><p class="css-1qa9noj interactive-leadin" data-testid="leadin" id="interactive-leadin">Cases per quarter</p></header><div class="css-17ih8de interactive-body" data-sourceid="100000010852318" id="embed-id-100000010852318"> <cript>window.registerInteractive && window.registerInteractive("100000010852318");</script> <cript src="https://static01.nytimes.com/newsgraphics/datawrapper/scripts/global-v1.js" type="text/javascript"></script> <iframe allowtransparency="true" frameborder="0" height="400" scrolling="no" src="https://datawrapper.dwcdn.net/B8Fa2/9/?plain=1" width="100%"></iframe></div><footer class="css-1rs1qmn interactive-footer" id="interactive-footer"><p class="css-jagbsj interactive-notes" data-testid="note" id="interactive-notes">A small share of cases, less than 1 percent, are categorized as "split decisions." They are not pictured.</p><p class="css-jagbsj interactive-source" data-testid="source" id="interactive-source">Source: Centers for Medicare and Medicaid Services</p><p class="css-jagbsj interactive-credit" data-testid="credit" id="interactive-credit">By The New York Times</p></footer></section></div><div data-testid="InteractiveBlock-4"><section class="interactive-content interactive-size-scoop css-kqcwdy" data-id="100000010852599" data-source-id="100000010852599" data-testid="inline-interactive" data-uri="nyt://embeddedinteractive/802f91f2-5e9b-5ec4-8726-ce70220f19a0" id="datawrapper_KUMpI"><header class="css-obecq5 interactive-header" id="interactive-header"><h2 class="css-4hk76s interactive-headline" id="interactive-headline">Dr. Rowe’s Winning Track Record</h2><p class="css-1qa9noj interactive-leadin" data-testid="leadin" id="interactive-leadin">Cases per quarter </p></header><div class="css-17ih8de interactive-body" data-sourceid="100000010852599" id="embed-id-100000010852599"> <cript>window.registerInteractive && window.registerInteractive("100000010852599");</script> <cript src="https://static01.nytimes.com/newsgraphics/datawrapper/scripts/global-v1.js" type="text/javascript"></script> <iframe allowtransparency="true" frameborder="0" height="400" scrolling="no" src="https://datawrapper.dwcdn.net/KUMpI/2/?plain=1" width="100%"></iframe></div><footer class="css-1rs1qmn interactive-footer" id="interactive-footer"><p class="css-jagbsj interactive-notes" data-testid="note" id="interactive-notes">The totals combine numerous variations on the names of Dr. Rowe's practices, Rowe Plastic Surgery and East Coast Plastic Surgery, in the public filing system.</p><p class="css-jagbsj interactive-source" data-testid="source" id="interactive-source">Source: Georgetown Center on Health Insurance Reforms.</p><p class="css-jagbsj interactive-credit" data-testid="credit" id="interactive-credit">By The New York Times</p></footer></section></div><div data-testid="Optimistic-5"><div class="css-kbghgg"><div class="css-121kum4"><div class="css-171d1bw"></div><div class="css-asuuk5"><noscript><div class="css-7axq9l" data-testid="optimistic-truncator-noscript"><svg aria-hidden="true" class="css-1b5b8u1" data-tpl="i" height="24" viewbox="0 0 24 24" width="24"><path clip-rule="evenodd" d="M2.5 12a9.5 9.5 0 1 1 19 0 9.5 9.5 0 0 1-19 0Zm8.5 1.75v-7.5h2v7.5h-2Zm0 2v2h2v-2h-2Z" fill="currentColor" fill-rule="evenodd"></path></svg><div class="css-6yo1no" data-testid="optimistic-truncator-noscript-message"><p class="css-3kpklk" data-tpl="t">We are having trouble retrieving the article content.</p><p class="css-3kpklk" data-tpl="t">Please enable JavaScript in your browser settings.</p></div></div></noscript><div class="css-1dv1kvn" id="optimistic-truncator-a11y" tabindex="-1"><hr/><p>Thank you for your patience while we verify access. If you are in Reader mode please exit and <a href="https://myaccount.nytimes.com/auth/login?response_type=cookie&amp;client_id=vi&amp;redirect_uri=https%3A%2F%2Fwww.nytimes.com%2F2026%2F04%2F22%2Fus%2Fpolitics%2Fdoctors-insurers-arbitration.html&amp;asset=opttrunc">log into</a> your Times account, or <a href="https://www.nytimes.com/subscription?campaignId=89WYR&amp;redirect_uri=https%3A%2F%2Fwww.nytimes.com%2F2026%2F04%2F22%2Fus%2Fpolitics%2Fdoctors-insurers-arbitration.html">subscribe</a> for all of The Times.</p><hr/></div><div class="css-1g71tqy" data-testid="optimistic-truncator-content"><svg aria-hidden="true" class="css-63woee" data-testid="optimistic-truncator-spinner" data-tpl="sp" height="24" viewbox="0 0 24 24" width="24"><g fill="currentColor"><path d="M11.28 22.8a.72.72 0 1 0 1.44 0v-6.72a.72.72 0 1 0-1.44 0v6.72Z" opacity=".37"></path><path d="M17.766 21.16a.72.72 0 1 0 1.165-.846l-3.95-5.436a.72.72 0 1 0-1.165.846l3.95 5.437Z" opacity=".26"></path><path d="M1.506 14.653a.72.72 0 0 0 .445 1.37l6.391-2.078a.72.72 0 1 0-.445-1.369l-6.39 2.077Z" opacity=".61"></path><path d="M5.07 20.314a.72.72 0 0 0 1.164.847l3.95-5.437a.72.72 0 1 0-1.165-.846l-3.95 5.436Z" opacity=".48"></path><path d="M22.049 16.022a.72.72 0 0 0 .445-1.37l-6.391-2.076a.72.72 0 1 0-.445 1.37l6.39 2.076Z" opacity=".17"></path><path d="M22.494 9.347a.72.72 0 1 0-.445-1.37l-6.391 2.078a.72.72 0 1 0 .445 1.369l6.39-2.077Z" opacity=".09"></path><path d="M6.234 2.84a.72.72 0 0 0-1.165.846l3.95 5.436a.72.72 0 0 0 1.165-.846l-3.95-5.437Z" opacity=".87"></path><path d="M1.951 7.978a.72.72 0 1 0-.445 1.37l6.391 2.076a.72.72 0 1 0 .445-1.37l-6.39-2.076Z" opacity=".74"></path><path d="M18.93 3.686a.72.72 0 0 0-1.164-.847l-3.95 5.437a.72.72 0 0 0 1.165.846l3.95-5.436Z" opacity=".02"></path><path d="M12.72 1.2a.72.72 0 1 0-1.44 0v6.72a.72.72 0 0 0 1.44 0V1.2Z"></path></g></svg><div class="css-6yo1no" data-testid="optimistic-truncator-message"><p class="css-3kpklk" data-tpl="t">Thank you for your patience while we verify access.</p><p class="css-3kpklk" data-tpl="t">Already a subscriber? <a class="css-z5ryv4" data-testid="log-in-link" href="https://myaccount.nytimes.com/auth/login?response_type=cookie&amp;client_id=vi&amp;redirect_uri=https%3A%2F%2Fwww.nytimes.com%2F2026%2F04%2F22%2Fus%2Fpolitics%2Fdoctors-insurers-arbitration.html&amp;asset=opttrunc">Log in</a>.</p><p class="css-3kpklk" data-tpl="t">Want all of The Times? <a class="css-z5ryv4" data-testid="subscribe-link" href="https://www.nytimes.com/subscription?campaignId=89WYR&amp;redirect_uri=https%3A%2F%2Fwww.nytimes.com%2F2026%2F04%2F22%2Fus%2Fpolitics%2Fdoctors-insurers-arbitration.html">Subscribe</a>.</p></div></div></div></div></div></div>