Answers / Who qualifies
Can surgery center claims use federal IDR?
Yes, in many cases. The No Surprises Act treats an ambulatory surgery center as a covered facility for scheduled care, so a clinician outside the plan's network who works at an in-network center cannot balance bill the patient for covered services. Anesthesiologists, pathologists, radiologists, assistant surgeons, and other ancillary clinicians cannot ask the patient to waive that protection, so unresolved payment goes to federal IDR for the plans the process covers. Surgeons can use a notice and consent form in some scheduled cases, and a center that is itself out of network is generally outside the Act.
Why a surgery center counts
For scheduled care, the Act's protections reach four kinds of site: ambulatory surgical centers, hospitals, hospital outpatient departments, and critical access hospitals. At an in-network center, a clinician who is out of network with the patient's plan must limit the patient's bill to in-network cost sharing for covered services, and the plan pays the clinician directly. When the plan's payment and the clinician's charge differ, the clinician can start open negotiation and then request federal IDR. In the 2025 files, 162,740 disputes included a line billed at place of service 24, the ambulatory surgical center code.
Who cannot be asked to waive
Ancillary services are those of emergency medicine, anesthesiology, pathology, radiology, neonatology, assistant surgery, hospitalist, and intensivist clinicians, plus diagnostic work such as laboratory tests and imaging. At an in-network center, the notice and consent form is unavailable to an out-of-network ancillary clinician, and the patient stays at in-network cost sharing. That matters here because 105,843 of the 162,740 disputes (65.04 percent) include an anesthesia code. A surgeon or other non-ancillary clinician may send written notice and collect a signed consent at least 72 hours ahead of a scheduled service, or at booking if the service is booked inside that period. The exception does not extend to unforeseen urgent needs that come up during the visit, or to services that no clinician in the center's network can provide.
What the Act does not reach
Medicare, Medicare Advantage, Medicaid, and TRICARE claims are excluded. A center that is out of network itself falls outside the Act for scheduled care, because the protections cover out-of-network clinicians at in-network facilities, and a patient who chooses an out-of-network center is not shielded. A fully insured plan in a state with its own surprise billing process follows the state's rules instead. Self-insured plans, which state laws generally cannot reach, made up 122,344 of the 162,740 disputes (75.2 percent), and fully insured group plans 16,852 (10.4 percent), which is why states with their own laws still show large federal counts.
Deadlines and filing costs
After the plan's initial payment or denial, the clinician has 30 business days to start open negotiation, and if negotiation fails, 4 business days after that period ends to request federal IDR. Check current requirements for your claim before relying on any date. Each party owes a $15 administrative fee on every dispute, plus an IDR entity fee paid up front that goes back to the winner. The median surgery center dispute in the 2025 files was decided in 31 days. Lido IDR confirms network status and plan type, tracks both deadlines, and files for a flat fee per arbitration, setting each offer from the results decided for similar claims at idrexplorer.com.
Check your surgery center claims against the rules
Lido IDR checks the facility's network status, the plan type, and the deadlines before filing, then files for a flat fee per arbitration. Talk to an IDR specialist.