Second Circuit Rejects Provider’s Bid to Enforce No Surprises Dispute Resolution Award Against Cigna
- September 18, 2026
- Written by AHLA Legal Staff
The Second Circuit affirmed September 17 that an out-of-network plastic surgery practice could not sue to enforce a $3 million arbitration award under the No Surprises Act (NSA) against Cigna Health and Life Insurance Company.
Joining most federal courts to consider the issue, including the Fifth Circuit, the Second Circuit found the NSA contains no express or implied right of action to enforce or confirm an independent dispute resolution (IDR) award. But see SpecialtyCare, Inc. v. CareFirst of Maryland, Inc., No. 25-cv-130-ABA (D. Md. June 9, 2026); PHI Health, LLC v. Optimum Choice, Inc., No. 25-cv-2320-ABA (D. Md. Mar. 27, 2026).
The NSA specifically provides that an IDR award is automatically “binding upon the parties involved” and “shall not be subject to judicial review” except in certain limited circumstances set forth in the Federal Arbitration Act (FAA). While the NSA incorporated the FAA’s provision for vacating arbitral awards, the statute did not do so for confirming them, which “strongly suggests that Congress did not intend to create a private right of action to enforce IDR awards,” the appeals court reasoned.
The fact the NSA delegates enforcement authority to multiple federal agencies and to states further reflects Congress’ intent that IDR awards “be enforced through administrative action rather than private litigation.”
East Coast Advanced Plastic Surgery, LLC (ECAPS) also could not seek a declaration under the Declaratory Judgment Act (DJA) that Cigna violated the NSA. It is well-established that the DJA does not provide an independent cause of action, the appeals court said in affirming the decision below. East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Ins. Co., No. 25 Civ. 255 (PAE) (S.D.N.Y. Aug. 14, 2025).
The consolidated action started when Cigna filed a complaint under the Employee Retirement Income Security Act (ERISA) against ECAPS, a New Jersey-based medical practice that specializes in post-mastectomy breast reconstruction surgery, alleging it engaged in fraudulent billing practices—including fee forgiveness, unbundling, and duplicate claims—that caused the insurer and claims administrator to overpay $8.5 million for the out-of-network provider’s services.
ECAPS countersued, alleging Cigna failed to fully pay for breast reconstruction services provided to patients enrolled in employer health plans that it administered. ECAPS brought its claims against Cigna under the NSA and the DJA for violating its obligation to pay IDR determinations within 30 days as required by the statute.
East Coast Advanced Plastic Surgery, LLC v. Cigna Health and Life Ins. Co., No. 25-2204 (2d Cir. Sept. 17, 2026).