What did the Second Circuit decide in East Coast Advanced Plastic Surgery v. Cigna?
Verdict Consulting Group Research · Updated
Answer
On September 17, 2026, the Second Circuit held that the No Surprises Act does not provide a private right of action to enforce IDR payment awards, and affirmed dismissal of a provider's suit over more than $3 million in awards against Cigna. It joined the Fifth Circuit, noting the Act cross-references FAA vacatur but not confirmation.
Detail
The decision
| Item | Detail |
|---|---|
| Court | U.S. Court of Appeals for the Second Circuit, No. 25-2204 |
| Panel | Leval and Park, Circuit Judges; Rakoff, District Judge (opinion by Judge Park) |
| Argued / decided | June 17, 2026 / September 17, 2026 |
| Below | S.D.N.Y. No. 25 Civ. 255 (Engelmayer, J.), dismissed August 14, 2025 |
| Holding | No private right of action to enforce IDR awards; affirmed |
The reasoning
The court found no express private right of action in the Act. It treated the Act's cross-reference to the FAA's vacatur provision (9 U.S.C. 10(a)), but not its confirmation provision (9 U.S.C. 9), as evidence that Congress did not intend private enforcement. In footnote 13 it expressly left open whether the Act's judicial-review bar forecloses suits to confirm awards ("We need not decide this issue"), assuming without deciding that it did not block this suit. It also held that the Declaratory Judgment Act supplies no independent cause of action.
The Second Circuit covers New York, Connecticut and Vermont. Because the decision binds district courts in the circuit, it effectively abrogates the District of Connecticut's 2025 holding in Guardian Flight v. Aetna that the Act implies a private right to enforce awards. It does not resolve whether a provider may still sue to confirm an award, the route the District of Connecticut took in Agag v. Cigna (Apr. 15, 2026), now on appeal.
Correction (2026-10-10): An earlier version said only that District of Connecticut implied-right decisions predate this ruling. We now state that the decision effectively abrogates Guardian Flight v. Aetna, and that footnote 13 leaves open whether confirmation suits are barred.
Read the analysis
Sources
- 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) ()
- U.S. District Court for the Southern District of New York (via CourtListener) — East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Insurance Co., No. 25 Civ. 255 (S.D.N.Y. Aug. 14, 2025), opinion and order ()
- 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 ()
- 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 ()
General information only, not legal advice. Verdict Consulting Group is not a law firm.