No Surprises Act shielded patients from big medical bills. Now its arbitration system may be raising costs.

A law designed to protect patients from surprise medical bills succeeded in eliminating unexpected charges, but spawned a lucrative arbitration industry with providers and specialized middlemen extracting payments far above benchmark billing rates.

The arbitration system Congress created to settle disputes between insurers and out-of-network providers allows doctors and resolution specialists acting on their behalf to win payments many times higher than typical rates for medical services. Those costs don't disappear: Much of the money comes from employer-sponsored health plans, meaning workers may ultimately pay through higher premiums or reduced benefits.

The plastic surgeon, Dr. Norman Rowe, routinely was awarded around 170 times the benchmark rates for his services under the NSA's arbitration system, a CBS News analysis of public data shows.

"Dr. Rowe uses the widely recognized gold standard FairHealth benchmarks set by the independent nonprofit FairHealth.org using reliable and objective market data. FairHealth data is so reliable that it is incorporated into statutes and regulations around the country and serves as the official data source for many state health programs," the spokesman added.

In addition to the typical benchmark rate arbitrators consider (known as the "qualifying payment amount," or QPA), FairHealth provides another rate that can be used during the dispute resolution process. Medicare rates, meanwhile, may not be considered.

In an arbitration under the No Surprises Act, insurers and providers each propose a rate for a given service. There's no room for negotiation, as an arbitrator must choose between one of the two parties' suggested figures.

Arbitrators side with providers in more than 85% of the cases, according to Leland Robbins, a product leader at Turquoise Health, a data transparency startup. Some arbitrators – officially called certified Independent Dispute Resolution, or IDR, entities – have track records of siding with providers in an even larger share of cases, according to Robbins' group.

"The transaction didn't go away. It went behind closed doors and has moved into this arbitration process when a payer and a provider can't agree what the fair price should be," Robbins said. "Given that 70% of these awards are being taken out of employer-sponsored health plans, consumers are going to start seeing it when it comes time for open enrollment."

Last year, 15 government-certified arbitrators earned fees per case, with 17 arbitrators designated to do this work today. Each side in the dispute — the healthcare provider and the insurer — pays into the process prior to the arbitrator making any decision.

However, HaloMD, a company that files cases on behalf of providers, told CBS News that the initial estimates "were objectively flawed in how they calculated expected volume."

Collectively, arbitrators making the decisions have earned more than $2 billion in fees. None agreed to on-camera interviews with CBS News.

New Jersey House Rep. Frank Pallone, a Democrat and the lead sponsor of the No Surprises Act, blames private equity, in part, for breaking the system he helped create.