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Providers Beware: Court Sides with Insurers in No Surprises Act Arbitration

Client Alert
July 2, 2025

On June 12, 2025, the Fifth Circuit ruled in favor of Aetna and Kaiser Foundation Health Plan (Kaiser) in a pair of cases filed by air ambulance providers challenging the No Surprises Act’s (NSA’s) Independent Dispute Resolution (IDR) process’ resolution of payment disputes. The NSA is a federal law seeking to protect patients from expensive and unexpected medical costs when seeking out-of-network care. To that end, the NSA created an IDR process for out-of-network providers and insurance companies to utilize to resolve payment disputes between the parties.

In this case, the air ambulance providers argued that Aetna and Kaiser miscalculated the providers’ Qualifying Payment Amount (QPA) during IDR. The QPA is the rate used to settle out-of-network claims. According to the providers, Aetna and Kaiser intentionally calculated and utilized a low QPA during the IDR process, potentially skewing the arbitrator’s findings as to the correct amount the insurers were required to pay for air ambulance care.

However, the Fifth Circuit disagreed with the providers, holding that, while the NSA permits limited court review of IDR outcomes, legal challenges to IDR decisions must be based on clear evidence of fraud or serious misconduct. The Fifth Circuit also ruled that the third-party arbitrator was immune from suit for their decisions in the IDR process.

Following this ruling, it is clear that courts will not second-guess the decisions made during IDR absent clear evidence of fraud and serious misconduct.

The case is Guardian Flight, L.L.C. v. Aetna Health, Inc., No. 24-20204 (5th Cir. 2025).

To learn more about the NSA and its IDR process, please contact BMD Healthcare Member Daphne Kackloudis at dlkackloudis@bmdllc.com or Attorney Jordan Burdick at jaburdick@bmdllc.com.

Health LawHealthcareDaphne KackloudisJordan Burdick
Client Alert

First-of-Its-Kind Federal Ruling Finds Use of Consumer AI Tool May Destroy Attorney-Client Privilege

February 17, 2026On February 10, 2026, Judge Jed Rakoff of the U.S. District Court for the Southern District of New York issued a first-of-its-kind ruling finding that documents generated by a criminal defendant using a consumer AI platform were not protected by attorney-client privilege after being shared with counsel. The court treated the AI tool as a third party, concluding that entering sensitive information into a publicly available platform may waive confidentiality. The ruling also suggests that the work product doctrine may not apply where AI-generated materials are created independently by a client rather than at counsel’s direction. The decision signals that parties should exercise caution when using consumer AI tools in connection with legal matters.Client Alert

Your Golden Chance for H-1B Lottery Registration - March 2026

February 16, 2026USCIS H-1B registration opens March 4–19, 2026. U.S.-based employees on valid nonimmigrant status are exempt from the $100,000 fee for change of status petitions. The new weighted lottery favors higher-skilled and higher-paid employees, improving odds for advanced degree holders and Wage Level 3 or 4 workers.Client Alert

Invisible Algorithms: The Hidden Role of Artificial Intelligence in USCIS Immigration Processing

February 10, 2026The Department of Homeland Security has confirmed that artificial intelligence and machine learning tools are now integrated into numerous operational functions within U.S. Citizenship and Immigration Services (USCIS). These tools are described as mechanisms to improve efficiency, reduce backlogs, and assist officers in managing an unprecedented volume of applications. DHS emphasizes that human adjudicators retain decision-making authority and that AI systems do not independently grant or deny immigration benefits. Find out how AI affects the U.S. immigration process.Client Alert

OAAPN | Year In Review: 2026 Ohio Board of Nursing and Ohio Law Rules

February 9, 2026Find out key changes to Ohio law and the Ohio Board of Nursing rules that have directly impacted APRN practice over the past year, including Psychiatric Inpatient Documents, Intimate Examinations, Signature Authority, Duties Related to Fetal Death, Retail IV Therapy Clinics, Release from Permanent Restrictions, Disciplinary Action, Course on Drugs and Prescriptive Authority, Overdose Reversal Drugs, Office Based Opioid Treatment, Withdrawal Management for Substance Use Disorder, Safe Haven Program, and more.Client Alert

Ohio House Bill 537: Proposed Regulations for Midwives and Birthing Centers

January 28, 2026House Bill 537, introduced in the Ohio House of Representatives, proposes a comprehensive regulatory framework for certified nurse-midwives, certified midwives, licensed midwives, and traditional midwives. The legislation would clarify scope of practice, establish licensure standards, and impose new requirements for freestanding birthing centers and home births. Healthcare providers and facilities should be aware of the proposed changes and their potential operational impact.
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