Courts Surprise by Gutting Provider Rights to Reimbursement Under No Surprises Act Providers often prevail in payment disputes, but many awards go unpaid

Courts Split on Provider Rights Under the No Surprises Act The No Surprises Act was designed to protect patients from unexpected medical bills and establish a fair process for resolving out-of-network reimbursement disputes. While providers have embraced the law’s Independent Dispute Resolution (IDR) process—and have prevailed in the vast majority of cases—many IDR awards remain unpaid. Recent data shows that health plans fail to honor more than half of these determinations, leaving providers in limbo. Two recent federal court decisions highlight the uncertainty surrounding enforcement. A Connecticut district court held that providers can sue to enforce IDR awards under the No Surprises Act and ERISA, recognizing a private right of action and standing for assigned claims. In stark contrast, the Fifth Circuit ruled that the Act bars judicial enforcement and that ERISA standing does not apply because patients face no financial liability under the Act. These conflicting rulings set the stage for further litigation—and possibly Supreme Court review—on whether providers have any judicial recourse when plans refuse to pay. Beyond enforcement, constitutional questions loom large, including potential challenges under the Seventh Amendment, Article III, and the Due Process Clause. For now, the answer to a simple question—what must health plans pay out-of-network emergency providers?—remains unsettled. Stakeholders should watch closely as courts and Congress grapple with these issues, which have significant implications for providers, payers, and patients alike.