Two major air ambulance providers, Guardian Flight LLC and Med-Trans Corporation, have asked the U.S. Supreme Court to review a key federal appeals court ruling related to the No Surprises Act (NSA). The petition for a writ of certiorari challenges a Fifth Circuit decision that concluded the NSA does not allow private parties to sue in court to enforce Independent Dispute Resolution (IDR) awards.
The case marks a significant development in ongoing litigation over how payment disputes under the NSA are enforced. If the Supreme Court agrees to hear the case, its ruling could shape how air ambulance and other out-of-network providers secure payment after arbitration.
Background of the No Surprises Act Litigation
The NSA, enacted in 2020, was designed to shield patients from unexpected medical bills, particularly for out-of-network emergency care. For services such as air ambulance transport, the law established a binding, baseball-style arbitration process to resolve payment disagreements between insurers and providers.
Guardian Flight and Med-Trans transported patients covered under ERISA-regulated health plans administered by Health Care Service Corporation. The patients assigned their benefits to the providers, giving them the right to collect payment. After prevailing in multiple IDR proceedings, the providers alleged that the insurer failed to pay the awarded amounts, prompting legal action to enforce the decisions.
Fifth Circuit Ruling and Provider Response
The Fifth Circuit upheld a lower court’s dismissal of the providers’ claims, ruling that the NSA does not create a private right of action to enforce IDR awards. The court found that while the statute describes awards as binding and requires insurers to pay within a set timeframe, it does not explicitly authorize providers to seek enforcement through the courts.
In their Supreme Court petition, the air ambulance providers argued that the statutory language reflects clear congressional intent to allow judicial enforcement. They contended that binding arbitration has historically been enforceable through courts and that mandatory payment language typically creates both a right and a remedy.
Broader Implications for Air Ambulance Payments
The petition also challenged the Fifth Circuit’s reliance on federal agency enforcement, asserting that regulators lack sufficient tools to compel timely compliance across thousands of cases. According to the providers, leaving enforcement solely to agencies risks allowing insurers to ignore arbitration outcomes, weakening the NSA’s core framework.
What Comes Next
With federal courts divided on this issue, the Supreme Court’s decision on whether to take the case could bring much-needed clarity. Until then, air ambulance providers, insurers, and regulators face continued uncertainty over how binding IDR awards truly are under the No Surprises Act.
