Guardian Flight, L.L.C., et al. v. Health Care Service Corporation

The No Surprises Act (“NSA”) is Congress’s solution to the problem of surprise medical bills. Under the NSA, insurers must cover services provided by out-ofnetwork emergency healthcare providers and pay providers directly. Patients cannot be billed for any unpaid balances. The NSA applies to both fully insured health plans and ERISA plans, meaning its coverage mandate is a benefit in every ERISA plan. The NSA channels out-of-network provider-insurer payment disputes into an arbitration-like independent dispute resolution process (“IDR”). The NSA expressly provides that IDR awards are “binding” and dictates that the insurer “shall” pay the provider any amounts owed within 30 days of an IDR determination. Petitioners are air-ambulance providers who transported patients covered by both traditional insurance and ERISA plans offered or administered by Respondent Health Care Service Corporation. The parties submitted their payment disputes to IDR, and Petitioners were awarded additional reimbursement. But Respondent did not pay. The questions presented are:

1. Whether, in keeping with American courts’ traditional recognition that a breach of contract is in itself an actionable injury, a breach of ERISA plan terms constitutes an injury in fact to an ERISA plan beneficiary, even where the beneficiary will not suffer any pocketbook injury.

2. Whether, when Congress provided that NSA IDR awards are “binding” and mandated that insurers “shall” pay them within 30 days, it intended to allow providers to sue in court to enforce the awards.