On September 17, the U.S. Court of Appeals for the Second Circuit reaffirmed that the No Surprises Act (NSA) does not provide out-of-network providers with a private right of action to enforce payment determinations issued through the independent dispute resolution (IDR) process.
The plaintiff in East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Insurance Company, No. 25-2204 (2d Cir. Sept. 17, 2026), had won more than $3 million in IDR awards against Cigna. Under the NSA, payment must be made within 30 days of the certified IDR entity’s final decision. When Cigna refused to pay the amounts awarded, the plaintiff filed suit in federal court. The plaintiff alleged that the NSA, in conjunction with the Declaratory Judgment Act, provided a basis to enforce the IDR awards and sought a declaration that Cigna violated the NSA’s requirement to issue payment. Separately, Cigna has alleged that the plaintiff engaged in improper billing practices that resulted in approximately $8.5 million in overpayments; this case is ongoing.
The court emphasized that the NSA contains no language expressly authorizing providers to sue insurers to enforce IDR awards. Applying traditional principles governing implied private rights of action, the court found that Congress’s creation of a detailed administrative enforcement mechanism, coupled with its omission of any private enforcement provision, indicated that Congress intended that agency oversight, rather than private litigation, should be the exclusive means of ensuring compliance with the NSA.
The ruling did not invalidate the underlying IDR awards, which may still be enforced (eventually) by the Centers for Medicare & Medicaid Services.
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