Providers continue to question how to handle collection of dispute resolution awards under the federal No Surprises Act (NSA) as the federal courts remain split on their interpretation of the NSA. Most recently, in June 2025, the US Court of Appeals for the Fifth Circuit decided Guardian Flight LLC et al. v. Health Care Service Corp., holding that providers do not have a private right of action to enforce dispute resolution awards under the NSA. In that case, the Fifth Circuit upheld a district court decision that dismissed two air ambulance providers’ suit against a health insurance company that sought to enforce out-of-network billing dispute resolution awards.
Congress enacted the NSA in 2022 in an effort to protect patients from surprise medical bills incurred from out-of-network healthcare providers. The NSA limited the out-of-pocket costs for patients and created an independent dispute resolution (IDR) process for billing disputes between providers and insurers. The outcome of the IDR process is a binding award that is not subject to judicial review.. The NSA gives the US Department of Health and Human Services (HHS) sole authority to enforce provider and payor noncompliance with the NSA.
In Guardian Flight LLC, the providers sued the health insurer for, among other things, failing to timely pay the providers 33 IDR awards, in violation of the NSA. The Fifth Circuit upheld the district court’s dismissal of the claim, reasoning that the NSA does not give providers a private right of action and that enforcement authority remains with HHS. The court reasoned that the NSA contains no explicit right of action, except in a case described in section 10(a) of the FAA (related to vacatur), and presumed that Congress did not intend to create any private cause of action.
The Fifth Circuit decision opposes another federal court stance on the issue. In May 2025, the US District Court for the District of Connecticut held in different Guardian Flight LLC case, that the NSA provides an implied private right of action for providers to enforce timely payment of IDR awards. The court focused on the direct language of the NSA requiring direct payment within 30 days and that the amounts are binding on the parties.
If circuit courts continue to disagree on the enforceability of IDR awards, the US Supreme Court will have to ultimately decide the issue. In the meantime, providers should become familiar with state law, as many states have passed laws similar to the NSA.