Cigna won a federal appeals court ruling Thursday blocking an out-of-network medical practice from suing to collect more than $3 million it won through the No Surprises Act’s dispute-resolution process.
The U.S. Court of Appeals for the Second Circuit affirmed the dismissal of claims brought by East Coast Advanced Plastic Surgery, or ECAPS, holding that the law requires payment of IDR awards but does not give healthcare providers a private right to sue insurers to enforce them.
ECAPS won more than $3 million through the law’s independent dispute resolution process after challenging payments involving Cigna-administered health plans. The No Surprises Act requires payment within 30 days of an IDR determination. According to the court, Cigna has made no payments on the awards.
Circuit Judge Michael H. Park wrote that the law’s text and structure show Congress placed enforcement authority with government regulators rather than private healthcare providers.
The No Surprises Act shields patients from certain unexpected out-of-network medical bills and created a process for resolving payment disputes between providers and health plans. When negotiations fail, each side submits a proposed amount to a certified IDR entity, which selects one of the offers. The resulting determination is binding.
ECAPS argued that the binding awards and mandatory payment language allowed providers to enforce the decisions in court. The Second Circuit found that Congress created a right to payment without creating a private federal cause of action to collect it.
The panel pointed to the law’s treatment of the Federal Arbitration Act. Congress incorporated provisions allowing courts to set aside IDR determinations on limited grounds, including fraud or misconduct, but omitted the provision used to confirm conventional arbitration awards in court.
Park said that omission supported the conclusion that Congress did not intend to create a separate private enforcement action under the No Surprises Act.
The court also pointed to the enforcement system Congress established through federal agencies and states. The Labor and Treasury departments have authority involving private employer-sponsored health plans, while the Department of Health and Human Services can enforce requirements involving certain government plans. States also have authority over health insurance issuers in circumstances covered by the statute.
ECAPS argued that relying on government enforcement could leave providers without an effective way to collect unpaid awards. The court said the question was whether Congress gave regulators enforcement authority, not how often they exercise it.
The practice also sought a declaration that Cigna owed the award amounts and violated federal law by failing to pay them. The Second Circuit rejected that claim, finding that the Declaratory Judgment Act could not create a standalone cause of action where the No Surprises Act supplied none.
The case is part of a broader billing dispute between the parties. Cigna has accused ECAPS of fraudulent billing practices that allegedly produced about $8.5 million in overpayments, including claims involving insufficient documentation, duplicate billing and medically unnecessary services. ECAPS has accused Cigna of paying substantially less than amounts owed for care provided to members of Cigna-administered health plans.
Thursday’s decision puts the Second Circuit alongside the Fifth Circuit, which reached the same conclusion in 2025. District courts had divided over whether providers could bring their own enforcement suits under the No Surprises Act, and the ruling now governs federal courts in New York, Connecticut and Vermont.
