On June 12, 2025, the Firth Circuit affirmed a Texas district court ruling finding that providers do not have standing to sue under the NSA or ERISA to enforce NSA awards. The Court reasoned that Congress did not expressly grant the right to sue to enforce an award except under limited circumstances not generally applicable. Instead, the Court stated that the NSA provides administrative remedies and enforcement through government agencies, mentioning that with the level of NSA disputes, Court would be overwhelmed with NSA litigation.
The Fifth Circuit order conflicts with the recent ruling of the Federal District Court of Connecticut holding that providers have standing to sue under the NSA, ERISA and State law in a suit against Aetna and Cigna. Aetna recently requested appeal to the Second Circuit given the conflict in these two cases and others involving provider rights to sue under the NSA and ERISA.
As previously reported, Congress was also reviewing enforcement of timely payment of NSA awards. In the prior Congress, a bill was introduced with penalties of three times the award amount for failure of an insurance company to make payment of the award within 30 days. While this bill lapsed, it will be interesting to see whether the Fifth Circuit ruling will lead to renewed congressional interest in NSA enforcement. We will continue to report on this important topic as provider rights under the NSA continue to evolve.
CHRMS has been dedicated to helping out-of-network providers navigate the often complex and time-sensitive NSA provisions under the Independent Dispute Resolution process, with great success. If you need assistance with NSA related or state surprise bill claims, please contact us – we’re here to help.