Skip to content
VerdictCONSULTING GROUP

Can a provider sue to enforce an IDR award?

Verdict Consulting Group Research · Updated

Answer

It depends on the court, but both appellate courts to rule say no. The Fifth Circuit (June 2025) and Second Circuit (September 17, 2026) hold the No Surprises Act creates no private right of action to enforce IDR awards. The Second Circuit left open whether suits to confirm awards are barred. The District of Maryland found a narrow implied right.

Detail

Where the courts stand

CourtDecisionPrivate right to enforce?
5th Cir.Guardian Flight v. HCSC, June 12, 2025; cert. denied Jan. 12, 2026No
2d Cir.East Coast Advanced Plastic Surgery v. Cigna, Sept. 17, 2026No
E.D. Pa.Advanced Vascular Assocs. v. Horizon BCBSNJ, Apr. 7, 2026No; FAA confirmation also unavailable
D. Md.PHI Health v. Optimum Choice, Mar. 27, 2026Yes, narrow implied right
D. Conn.Guardian Flight v. Aetna, May 14, 2025Yes, implied; effectively abrogated by the Second Circuit
D. Conn.Agag v. Cigna, Apr. 15, 2026 (judgment Apr. 16)None found; awards confirmed; NSA damages and FAA § 9 claims dismissed; on appeal (2d Cir. No. 26-1241)

In 2025, the District of Connecticut held in Guardian Flight v. Aetna (May 14, 2025) that the Act implies a private right of action to enforce IDR awards. The Second Circuit's decision, which binds district courts in Connecticut, effectively abrogates that holding. Agag v. Cigna took a different route: on April 15, 2026, the court dismissed the provider's NSA damages claim and his FAA section 9 claim, but confirmed the awards without finding an implied right, reasoning that confirmation is not barred "judicial review." It entered judgment for $142,567.99 on April 16, 2026, and Cigna's appeal is pending in the Second Circuit (No. 26-1241). Courts in the Northern District of Illinois have held there is no private right. For every decision and its citation, see Can a provider sue to enforce an unpaid IDR award? Where the courts stand after the Second Circuit.

The open question: confirmation suits

The Second Circuit did not decide whether the Act's bar on judicial review also forecloses a suit to confirm an award. In footnote 13 it said "We need not decide this issue," assuming without deciding that the bar did not block the provider's suit. Whether a provider can confirm an award in the Second Circuit, as in Agag, remains open.

What the rulings turn on

Courts finding no right point to the Act's cross-reference to FAA vacatur but not confirmation, and to the Departments' enforcement authority. The District of Maryland read the Act's statements that determinations are "binding" and must be paid within 30 days as authorizing a narrow action to convert an unpaid award into a judgment.

Correction (2026-10-10): An earlier version listed the Eleventh Circuit as holding there is no private right to enforce awards; its REACH Air Medical Services v. Kaiser decision concerned a provider's attempt to vacate an award. It also described the Second Circuit case as pending; the court decided it on September 17, 2026.

Correction (2026-10-10): An earlier version said District of Connecticut courts found an implied right in 2025 and 2026. Only Guardian Flight v. Aetna (May 14, 2025) did so, and the Second Circuit's decision effectively abrogates it. Agag v. Cigna (Apr. 15, 2026) dismissed the NSA damages and FAA claims and confirmed the awards without finding an implied right. We also noted that the Second Circuit left open whether confirmation suits are barred.

Read the analysis

Sources

  1. U.S. Court of Appeals for the Fifth Circuit — Guardian Flight, L.L.C. v. Health Care Service Corp., No. 24-10561 (5th Cir. June 12, 2025) ()
  2. Supreme Court of the United States — Docket No. 25-441, Guardian Flight, L.L.C. v. Health Care Service Corporation ()
  3. U.S. Court of Appeals for the Second Circuit (opinion text via FindLaw) — East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Insurance Co., No. 25-2204 (2d Cir. Sept. 17, 2026) ()
  4. U.S. District Court for the District of Maryland — PHI Health, LLC v. Optimum Choice, Inc., No. 25-cv-2320 (D. Md. Mar. 27, 2026), memorandum opinion ()
  5. U.S. District Court for the Eastern District of Pennsylvania (via GovInfo) — Advanced Vascular Associates v. Horizon Blue Cross Blue Shield of New Jersey, No. 2:25-cv-05068 (E.D. Pa. Apr. 7, 2026), memorandum ()
  6. U.S. District Court for the District of Connecticut (via GovInfo) — Guardian Flight LLC v. Aetna Life Insurance Co., No. 3:24-cv-00680 (D. Conn. May 14, 2025), ruling on motions to dismiss ()
  7. U.S. District Court for the District of Connecticut (court filing hosted by the O'Neill Institute) — Agag v. Cigna Health and Life Insurance Co., No. 3:25-cv-00498 (D. Conn. Apr. 15, 2026), order on motion to dismiss and cross-motion to confirm ()
  8. U.S. District Court for the District of Connecticut (court filing hosted by the O'Neill Institute) — Agag v. Cigna Health and Life Insurance Co., No. 3:25-cv-00498 (D. Conn. Apr. 16, 2026), judgment ()

General information only, not legal advice. Verdict Consulting Group is not a law firm.