Providers Ask Supreme Court to Weigh in on No Surprises Act Enforcement

Two air ambulance companies — Guardian Flight LLC and Med-Trans Corporation — have petitioned the Supreme Court of the United States to review whether providers can use the courts to enforce payment awards under the No Surprises Act (“NSA”).¹ The providers argue that, without judicial review, insurers could ignore arbitration awards issued through the NSA’s Independent Dispute Resolution (“IDR”) process.

Enacted in 2022, the NSA established the IDR process to resolve payment disputes between healthcare providers and insurers for out-of-network services — particularly in emergency situations or when patients have no choice of provider. The IDR process functions as a form of binding arbitration: after negotiations fail, both parties submit their best payment offers to a neutral arbiter, who selects one based on factors such as median in-network rates, service complexity, and geographic considerations. This mechanism was designed to remove patients from billing disputes, ensuring they are only responsible for in-network cost-sharing amounts while providers and insurers resolve payment disagreements directly through the arbitration system.

At the district court, the air ambulance companies sued Health Care Service Corporation for failing to timely pay dispute resolution awards under the NSA.² The district court dismissed the case, ruling that the NSA does not contain a private right of action.³ In June 2025, the United States Court of Appeals for the Fifth Circuit affirmed the dismissal, agreeing that the NSA does not allow for a private right of action.⁴ The Fifth Circuit also affirmed the district court’s ruling that the providers lacked standing under ERISA.

In their October 8 petition to the Supreme Court, the providers argue that the Fifth Circuit wrongly held that the NSA does not create a private right of action and that providers lack standing under ERISA absent a direct financial injury. The providers assert that these rulings undermine the NSA’s intent to create a fair payment mechanism while protecting patients from balance billing.

The Fifth Circuit’s ERISA ruling conflicts with decisions from the United States Court of Appeals for the Sixth and Eighth Circuits, setting up a potential circuit split on whether beneficiaries (and by extension, providers) may bring similar claims without showing out-of-pocket loss. The outcome of this petition could significantly affect how providers enforce arbitration awards under the NSA and pursue payment disputes with insurers.

[1] See Guardian Flight LLC v. Health Care Serv. Corp., 735 F. Supp. 3d 742 (N.D. Tex. 2024) here.

[2] Id.

[3] Id. at 751.

[4] See Guardian Flight, LLC v. Health Care Serv. Corp., 140 F.4th 271 (5th Cir. 2025).