No Surprises Act (“NSA”)
Congress passed the No Surprises Act (“NSA”) to address the issue of “surprise billing.” Among other provisions, the NSA generally limits the amount an insured patient will pay for emergency services furnished by an out-of-network provider and for certain non-emergency services rendered by an out-of-network provider at an in-network healthcare facility. 42 U.S.C. §§ 300gg-111, 300gg-131, 300gg-132. Under the NSA, healthcare providers must instead seek payment from health plans or health insurance issuers to pay for these services. Id. § 300gg111(c)(1)(A).
These provisions of the NSA also apply to air ambulance services. Id. § 300gg-112. After an insured patient receives air ambulance services, the NSA requires group health plans or health insurance issuers to send an initial payment or notice of denial of payment to the air ambulance service provider within 30 days. Id. § 300gg-112(a)(3)(A). The provider then has 30 days from the date of payment or notice of denial of payment to initiate negotiations to determine an agreed-upon amount for air ambulance services. Id. § 300gg-112(b)(1)(A). However, if negotiations fail, then either side may initiate arbitration through the “independent dispute resolution process.” Id. § 300gg-112(b)(1)(B). A “certified IDR entity” oversees the IDR process, during which each side submits an offer for a payment amount, as well as any other information requested by the certified IDR entity relating to the offer. Id. § 300gg112(b)(4), (5)(B). Then, in “baseball-style arbitration” — in which an arbitrator must choose one of the offers submitted by the parties and cannot select any other figure — the certified IDR entity selects one of the offers submitted to be the amount of payment for air ambulance services rendered. Id. § 300gg-112(b)(5)(A)(i). Neither party can respond to the other party’s submission.
Present Case
REACH Air Medical Services LLC (“Reach”), a provider of air ambulance services, and Kaiser Foundation Health Plan Inc. (“Kaiser”), a health maintenance organization, had an insurance coverage dispute arising from Reach providing emergency air ambulance services to a patient insured by Kaiser in February 2022. Reach was not in-network with Kaiser. After failing to agree about how much Reach should be paid for the transport, Kaiser and Reach commenced the Independent Dispute Resolution (“IDR”) process outlined in the federal No Surprises Act, 42 U.S.C. §§ 300gg-111–139. Each submitted its offer and rationale to the assigned arbitrator, C2C Innovative Solutions, Inc. (“C2C”) pursuant to the rules and procedures governing the NSA. When C2C chose Kaiser’s offer of $24,813.48, Reach accused Kaiser of fraud, since Kaiser had submitted a lower figure for its Qualifying Payment Amount (“QPA”) to C2C during the IDR process than it did to Reach before IDR had commenced. Reach sued Kaiser and C2C in the Middle District of Florida to vacate C2C’s IDR determination. The district court dismissed Reach’s Complaint without prejudice and also dismissed C2C from the case with prejudice. Reach appealed.
The United States Court of Appeals stated in its November 19, 2025 published opinion: “The district court got it right. We review arbitration decisions very narrowly, and there is a strong legal presumption that arbitration awards will be confirmed. Nothing in the newly codified NSA, which has expressly incorporated some sections of the Federal Arbitration Act (“FAA”), has altered that limited scope of judicial review. The Complaint does not come close to alleging what is required to vacate an arbitration award under the FAA for fraud or undue means or because the arbitrator exceeded its authority. Accordingly, we affirm the district court’s dismissal in full.”
Source REACH Air Medical Services LLC v. Kaiser Foundation Health Plan Inc., C2C Innovative Solutions, Inc., No. 24-10135.
If you or a family member were injured due to air ambulance negligence in the United States, you should promptly find a medical malpractice lawyer in your state who may investigate your air ambulance negligence claim for you, and represent you or your family member in an air ambulance negligence case, if appropriate.
Click on the “Contact Us Now” tab to the right, visit our website, or call us toll-free in the United States at 800-295-3959 to find air ambulance negligence lawyers in your state who may assist you.
Turn to us when you don’t know where to turn.
