What the East Coast Decision Means for Out-of-Network Physicians
In East Coast Advanced Plastic Surgery, LLC v. Cigna Health & Life Insurance Co., the provider obtained more than $3 million in favorable federal Independent Dispute Resolution (IDR) awards but alleged Cigna did not pay them. On September 17, 2026, the U.S. Court of Appeals for the Second Circuit held that the No Surprises Act does not give providers a private right to sue a health plan simply for failing to pay an IDR award within the statute’s 30-day period. The court concluded that Congress assigned enforcement primarily to federal and state regulators. East Coast, No. 25-2204, 2026 WL 2751786 (2d Cir. Sept. 17, 2026).
Health plans are likely to rely on East Coast to seek dismissal of lawsuits framed solely as direct claims under the No Surprises Act. Providers should therefore avoid assuming a favorable IDR determination can be collected through a stand-alone federal statutory claim.
The decision does not mean, however, that a plan may disregard an IDR award without consequence. East Coast addressed the particular claim before it. It did not decide every possible legal theory for recovering an unpaid award.
For example, Agag v. Cigna Health & Life Insurance Co., a Connecticut federal court treated recognition of a completed IDR determination as a limited, ministerial proceeding rather than a new lawsuit to decide the dispute. Agag, No. 3:25-cv-00498, 2026 WL 1021213 (D. Conn. Apr. 15, 2026). East Coast creates uncertainty for this approach, but it did not expressly address Agag’s precise reasoning and declined to decide whether the No Surprises Act categorically bars confirmation or enforcement proceedings.
A provider may have a separate contract claim if the plan or administrator made enforceable commitments through negotiations, IDR submissions, certifications, agreements or post-award communications. East Coast did not address claims based on a payor’s own contractual obligations.
If a payor made a clear promise, the provider reasonably relied on it, and that reliance caused harm, a state-law promissory estoppel claim may also be available. The strength of this claim will depend on the specific words, documents and conduct involved.
To give themselves the best chance to prevail on these claims and avoid dismissal based on East Coast, providers should:
- Preserve all open-negotiation communications, IDR notices, submissions, certifications, award determinations, payment-status messages and post-award correspondence.
- Identify any statement that the payor would treat the IDR outcome as binding or would process payment after the award.
- Review pending and potential lawsuits to ensure they do not rely only on a direct No Surprises Act claim.
- Continue reporting unpaid or delayed awards through available regulatory channels while evaluating judicial remedies.
In conclusion, East Coast is an important limitation on provider enforcement rights, but it is not necessarily the end of the road. The best path forward will depend on how the claim was presented, what the payor promised and what occurred before and after the IDR award.
Harris Beach Murtha’s Health Care Industry Team regularly tracks and supports clients with issues related to the No Surprises Act. If you need help, please reach out to attorney Roy W. Breitenbach at (516) 880-8378 and rbreitenbach@harrisbeachmurtha.com or the Harris Beach Murtha attorney with whom you most frequently work.
This alert is not a substitute for advice of counsel on specific legal issues.
Harris Beach Murtha’s lawyers and consultants practice from offices throughout Connecticut in Bantam, Hartford, New Haven and Stamford; New York State in Albany, Binghamton, Buffalo, Ithaca, New York City, Niagara Falls, Rochester, Saratoga Springs, Syracuse, Long Island and White Plains; as well as in Boston, Massachusetts; Providence, Rhode Island. and Newark, New Jersey.