What did the Second Circuit decide?
The Second Circuit held that the No Surprises Act does not create an implied private right of action for a provider to sue in federal court solely to collect an unpaid IDR award. In East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Insurance Company, the court also concluded that the Declaratory Judgment Act did not supply a separate cause of action.
The ruling affirmed dismissal of the claims before the court. It joins the Fifth Circuit's approach, but it should not be reduced to the claim that an insurer may freely ignore a final determination.
What the ruling did not change
The ruling does not make IDR awards optional: they remain binding, and the statutory 30-day payment obligation remains in place. The court expressly recognized both features of the federal scheme while concluding that Congress assigned enforcement to federal and state authorities rather than creating the private federal action asserted in this case.
The opinion identifies administrative enforcement roles for the Department of Labor and Treasury for many private employer plans, HHS for certain governmental plans, and state regulators for issuers where state enforcement applies. Which channel fits a particular nonpayment matter depends on the plan, payer, issuer, and governing regulatory structure.
Where does the decision apply?
The decision is binding federal appellate precedent in New York, Connecticut, and Vermont. It also aligns with the Fifth Circuit's treatment of the issue in Texas, Louisiana, and Mississippi.
It is not binding precedent in New Jersey's Third Circuit. Courts elsewhere may consider the opinion persuasive, and the absence of binding circuit precedent does not guarantee a different result.
Halkovich Law's perspective
The result exposes a serious enforcement gap: a provider may complete the federal process, obtain a binding award, reach the statutory payment date, and still face a separate regulatory effort to obtain compliance. That makes precise records and prompt escalation more important, not less.
Providers should preserve the final determination, proof of receipt, the 30-day payment calendar, remittance and bank records, follow-up correspondence, and the identities of the plan, third-party administrator, and issuer. A regulator submission should make the timeline and unpaid amount easy to verify.
The court did not decide every potentially available contractual, statutory, or state-law theory. Whether an independent claim exists depends on the assignments, plan terms, standing, preemption, venue, governing law, and facts of the particular dispute. This decision should not be read as a prediction that any alternative theory will succeed.
Practical steps for an unpaid award
- Confirm the determination date, receipt date, amount, and statutory payment deadline.
- Preserve the complete IDR file, including initiation materials, offers, notices, and the final determination.
- Document nonpayment or partial payment with remittance records and dated correspondence.
- Identify the plan type, responsible payer entities, issuer, and the regulators with potential authority.
- Evaluate jurisdiction and any claim-specific legal theory before selecting an enforcement path.
Frequently asked questions
Did the Second Circuit cancel federal IDR awards?
Can a provider sue under the NSA in New York, Connecticut, or Vermont?
How can an unpaid award be addressed?
Does the ruling bind providers in New Jersey?
Sources and scope
This article is Halkovich Law's provider-side commentary on a recent appellate decision. It is general information, not claim-specific legal advice, and it does not predict the outcome of another case or regulatory submission.
Build the record before choosing the route.
Halkovich Law can assess an unpaid determination, the responsible entities, jurisdiction, and available next steps.