Federal Courts Split on No Surprises Act Private Right of Action

Providers continue to question how to handle collection of dispute resolution awards under the federal No Surprises Act (NSA) as the federal courts remain split on their interpretation of the NSA. Most recently, in June 2025, the US Court of Appeals for the Fifth Circuit decided Guardian Flight LLC et al. v. Health Care Service Corp. , holding that providers do not have a private right of action to enforce dispute resolution awards under the NSA. In that case, the Fifth Circuit upheld a district court decision that dismissed two air ambulance providers’ suit against a health insurance company that sought to enforce out-of-network billing dispute resolution awards.

Congress enacted the NSA in 2022 in an effort to protect patients from surprise medical bills incurred from out-of-network