Knowledge Center

On June 17, 2026, the U.S. Court of Appeals for the Second Circuit is scheduled to hear oral argument in East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Insurance Company, No. 25-2204. The case is primarily important for out-of-network providers because it concerns whether a provider in the states within the Second Circuit, which are New York, Connecticut, and Vermont, can sue in federal court to enforce unpaid Independent Dispute Resolution awards rendered under the No Surprises Act (“NSA”). The appeal arises from a lower court ruling that declined to find that the NSA allows such actions.

The only other federal appeals court to rule on this issue is the Fifth Circuit Court of Appeals. That court held in Guardian Flight, L.L.C. v. Health Care Service Corp. No. 24-10561(5th Cir. 2025), that the NSA does not create a private right of action allowing providers to sue in court to enforce IDR awards. The Fifth Circuit Court of Appeals has jurisdiction over Louisiana, Mississippi, and Texas. The US Supreme Court declined to review the Fifth Circuit’s Opinion.

Most federal courts, with some exceptions, have also held that providers cannot sue to enforce unpaid NSA awards. Two notable and recent exceptions are PHI Health, LLC v. Optimum Choice, Inc., 2026 WL 850453 (D. Md. Mar. 27, 2026), and Richard Agag, MD v. Cigna Health and Life Insurance Company, 2026 WL 1021213 (D. Conn. Apr. 15, 2026).
Because courts of appeal are very influential even outside of the states in which they have jurisdiction, the Second Circuit Court of Appeals’ decision in this case will be consequential. If it decides in favor of providers, out-of-network providers in New York, Connecticut, and Vermont will have strong appellate authority supporting their ability to go to court to enforce unpaid NSA IDR awards, and providers in other jurisdictions will have an important decision to cite in arguing that IDR awards must be enforceable. And if two circuit courts disagree, the Supreme Court will be more likely to weigh in on this issue, if it is asked to.

Should the Second Circuit decide against providers, payors will have another appellate decision supporting the argument that providers cannot sue under the NSA to enforce unpaid IDR awards, making it harder for providers to obtain payment when a payor refuses to honor an IDR determination.

During the oral argument on this case, lawyers for both sides will answer questions from the appellate judges. The court will later issue a written decision. There is no fixed deadline for that decision.

We will continue to follow developments like these that affect the out-of-network provider community and keep you informed.