The U.S. Court of Appeals for the Fifth Circuit has affirmed two decisions of a lower court barring air ambulance providers from privately enforcing independent dispute resolution (IDR) awards under the No Surprises Act (NSA). The appellate court also reversed the lower court's decision in one of the cases that had allowed the provider's claim against the certified IDR entity to go forward. The cases are Guardian Flight, L.L.C. v. Health Care Serv. Corp., 2025 WL 1661358 (5th Cir. 2025) and Guardian Flight, L.L.C v. Medical Evaluators of Tex. ASO, L.L.C., 2025 WL 1661357 (5th Cir. 2025).
Congress enacted the NSA as part of the Consolidated Appropriations Act, 2021. The purpose of the NSA is to provide consumers with protection against unexpected medical bills. Among other provisions, the NSA established an IDR process to determine out-of-network payment amounts between providers, including air ambulance providers, and health insurance plans.
Guardian Flight, L.L.C., sued an insurer after it failed to pay an IDR award for disputed services, alleging violations of the NSA and the Employee Retirement Income Security Act (ERISA). The trial court dismissed the case, finding that the NSA did not create a private right of action for providers to enforce IDR awards. Furthermore, the trial court held that Guardian Flight had no standing to bring ERISA claims, even though some plan participants had assigned their rights to the provider. Therefore, Guardian Flight could not claim an ERISA violation for improper denial of benefits because under the NSA, participants were not responsible for paying the claims. Due to the lack of responsibility for payment, the participants suffered no concrete injury from the denial of benefits.
On appeal, the Fifth Circuit affirmed the trial court's dismissal of the claim. The appellate court also pointed out that the plain text of the NSA bars private suits such as those filed by Guardian Flight. Since Congress expressly prohibited these types of suits in drafting the NSA, the court stated that it also could not find an implied right of action. Based on the same reasoning, the Fifth Circuit also affirmed the trial court's dismissal of a second case that Guardian Flight had filed against a different insurer.
However, in the second case, Guardian Flight also sued the certified IDR entity, or the neutral third party assigned to determine the amount of the IDR award. The trial court had allowed the claim against the certified IDR entity to proceed, rejecting its argument that its function was akin to that of an arbitrator, which entitled it to immunity.
The Fifth Circuit disagreed, reversing the trial court's rejection of the certified IDR entity's claim of immunity. The appellate court found that since certified IDR entities function like arbitrators, they are entitled to the same immunity from suit that arbitrators typically enjoy.
While group health plans and insurers may applaud the prohibition on providers enforcing IDR awards in court, they should keep in mind that the NSA allows the U.S. Department of Health and Human Services to enforce IDR awards through administrative penalties.
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