A coalition of 67 health care industry and advocacy groups is urging Congress to revisit a surprise medical billing law to address an unforeseen problem from its enactment: the ballooning costs of settling disputes when services are performed out of network.

The industry groups sent a letter to congressional leadership on Thursday pushing for changes to the so-called No Surprises Act, enacted in 2020, which successfully shielded patients from out-of-network bills in most scenarios. But advocates say it created a problem over how disputes between a hospital, for example, and an insurance company are settled via the law’s “baseball-style” arbitration when there is no pre-negotiated contract between the two.

In that kind of arbitration, each side submits a single price and an arbitrator must pick one with no middle ground.

Melissa Bartlett, senior vice president for health policy at the ERISA Industry Committee, said on a call with reporters that the law’s arbitration process has created a “massive unforeseen crisis in employer-sponsored coverage.”

The push comes as members on the House and Senate committees with health care jurisdiction have signaled interest in cracking down on the high cost of surprise billing arbitration. Senate Health, Education, Labor and Pensions Chair Bill Cassidy, R-La., plans to hold a members roundtable discussion of HELP committee members in the coming weeks to discuss different ideas to fix the law.

Rep. Frank Pallone Jr., D-N.J., the​ top Democrat on the House Energy and Commerce Committee, is also taking aim at arbitration firms that he believes are acting nefariously, while House Ways and Means Republicans are looking at ways to address rising arbitration costs associated with the law.

Having parties go to arbitration was supposed to be a rare phenomenon, but in many cases it’s now the default — and providers generally win, receiving payouts averaging over six times the local in-network rates. Providers have secured an additional $15 billion in arbitration payments in 2025 alone.

Health policy analysts have found that the arbitration payouts are contributing to higher premiums for both employers and employees.

The advocacy groups want to scrap this system in favor of benchmarking disputed payments to what Medicare pays or median in-network rates.

That’s what the coalition members, led by nonpartisan health care advocate Families USA, urged Congress to do during the first surprise billing debate. But after years of lobbying by hospitals, insurers and consumer groups, Congress settled on the current method, also called independent dispute resolution.

The groups say the soaring costs have shown that Congress chose poorly.

“Without a benchmark or guardrails to guide the arbitrator, the settled disputes in this period provided payments far above that median in-network rate,” Families USA Executive Director Anthony Wright told reporters on the call.

The groups’ letter went to Senate Majority Leader John Thune, R-S.D., Minority Leader Charles E. Schumer, D-N.Y., House Speaker Mike Johnson, R-La., and Minority Leader Hakeem Jeffries, D-N.Y.

The House especially has little time to act. After this week, the chamber is expected to remain in recess until after the election, leaving a few legislative weeks in the lame-duck session.

The coalition is pushing Congress to act during that period.

Jane Sheehan, Families USA deputy senior director of government relations, said it will be tough to get anything done in that time. But if not, at least the ball is rolling for the next Congress.

“Even if we can’t get everything we want to get done this year, the problems will persist and continue,” Sheehan said.