Knowledge Center

On June 17, 2026, the U.S. Court of Appeals for the Second Circuit heard oral argument in East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Insurance Company, No. 25-2204. The case is important for out-of-network providers because it concerns whether a provider can sue in federal court to enforce unpaid Independent Dispute Resolution awards rendered under the No Surprises Act (“NSA”).

The Second Circuit includes New York, Connecticut, and Vermont. The Second Circuit’s decision will directly affect providers seeking to enforce unpaid NSA IDR awards in those states. It will also likely influence courts in other jurisdictions because federal appellate decisions are often influential beyond the states in which they are binding.

The only federal appeals court to have ruled on this issue so far is the Fifth Circuit. In Guardian Flight, L.L.C. v. Health Care Service Corp., No. 24-10561 (5th Cir. 2025), the Fifth Circuit held that the NSA does not create a private right of action allowing providers to sue in court to enforce IDR awards. The Fifth Circuit includes Louisiana, Mississippi, and Texas. The U.S. Supreme Court declined to review that decision.

A similar issue is now pending in the Third Circuit, which includes New Jersey, Pennsylvania, Delaware, and the Virgin Islands. That appeal is SpecialtyCare Inc., et al. v. Cigna Healthcare Inc., No. 26-1768, consolidated with SpecialtyCare Inc., et al. v. UMR Inc., No. 26-1769. It arises from Delaware federal court decisions dismissing SpecialtyCare’s claims seeking to enforce unpaid NSA IDR awards.

The Third Circuit appeal is already affecting trial-court litigation. On June 15, 2026, Chief Judge Renée Marie Bumb of the District of New Jersey issued an order staying and administratively terminating NSA cases seeking to enforce IDR awards in that court pending the Third Circuit’s decision in the consolidated SpecialtyCare appeals. As a result, those cases in the District of New Jersey are effectively on hold.

A provider-favorable Second Circuit ruling would give providers in New York, Connecticut, and Vermont strong appellate authority supporting judicial enforcement of unpaid NSA IDR awards. A provider-favorable Third Circuit ruling would do the same for providers in Delaware, New Jersey, and Pennsylvania, and would likely affect the stayed District of New Jersey cases.

On the other hand, payor-favorable decisions would give insurers additional appellate authority to argue that NSA IDR awards are not privately enforceable in court. If either the Second or Third Circuit disagrees with the Fifth Circuit, that circuit split could increase the likelihood that the Supreme Court eventually addresses the issue.

We will continue to monitor these developments and keep you informed.