On May 14 U.S. District Court for the District of Connecticut issued a ruling that gives providers a win in the ongoing fight to get paid for arbitration awards issued under the No Surprises Act (NSA) Independent Dispute Resolution (IDR) process.
In this case, six air ambulance companies sued Aetna and Cigna for failing to timely pay more than $20 million in IDR awards within the required 30-day window. The plaintiff was seeking to enforce the IDR awards under the NSA and ERISA, as well as under State law deceptive trade practices act. As previously reported, courts have been inconsistent in determining whether providers have a private right of action under the NSA to sue in Federal court to enforce an IDR award.
In this case, the Court found that providers do have standing under the NSA, stating:
“the NSA’s text and structure evinces an intent to allow for judicial enforcement. As noted already, the NSA contains strong, mandatory language regarding health plans’ and insurers’ payment obligations and the “binding” effect of IDR awards. As the Supreme Court has held in another context, such mandatory text “often reflects congressional intent to create both a right and a remedy” for the individuals to whom payment is due. … In sum, I conclude that the NSA creates a private cause of action to enforce IDR awards.”
The Court also let stand claims for violations of ERISA and State deceptive trade practices laws.
While conflicts among court rulings on this issue continue to exist, this decision supports that providers have a private right of action under the NSA to pursue enforcement of awards when insurers fail to timely pay binding arbitration decisions – offering providers an important path to obtaining timely payment of NSA awards. .
There are many other cases filed across the country raising the same issues decided in this case. We expect that Courts will continue to issue conflicting rulings on providers private right of action under the NSA and we will continue to update as warranted.