Summary
The District of New Jersey grants Horizon Blue Cross Blue Shield of New Jersey’s motion to dismiss and denies Douglas Spiel, MD, PA’s cross-motion to confirm an Independent Dispute Resolution determination under the No Surprises Act. The court holds that the statutory IDR process is not an arbitration eligible for confirmation under Section 9 of the Federal Arbitration Act because the parties lacked a written arbitration agreement. It further concludes that the No Surprises Act does not create an express or implied private right of judicial enforcement for IDR awards and instead provides an administrative enforcement scheme.
Topics
Practice areas
Questions Presented
- Whether a No Surprises Act Independent Dispute Resolution determination is an arbitration award eligible for confirmation under section 9 of the Federal Arbitration Act when the parties had no written arbitration agreement.
- Whether the No Surprises Act creates an express or implied private right of action allowing a provider to obtain judicial confirmation or enforcement of an IDR determination.
- Whether Defendant waived its challenge to Plaintiff's enforcement method by not separately petitioning to vacate the IDR determination.
Holdings
- A No Surprises Act IDR determination is not an arbitration award eligible for confirmation under section 9 of the FAA where the parties did not enter into a written arbitration agreement.
- The No Surprises Act does not create an express or implied private cause of action for judicial confirmation or enforcement of an IDR determination.
- Defendant did not waive its argument for dismissal by failing to petition to vacate the IDR determination because Defendant challenged Plaintiff's method of enforcement rather than the validity of the determination.
Key quotations
“the FAA reflects the fundamental principle that arbitration is a matter of contract.” (8)
“Nothing in the NSA “unambiguously manifests” an intent to authorize private lawsuits by providers to enforce IDR determinations.” (15)
Factual background
Plaintiff, an out-of-network radiology provider, treated patient E.B. at Bayonne Medical Center on October 25, 2022, and billed Defendant $103,320, while Defendant allowed $460.04. After the parties failed to resolve the payment dispute through the No Surprises Act negotiation process, an IDR entity selected Plaintiff's final offer of $50,000 on August 30, 2024. Defendant did not pay the remaining $46,871.73 by the statutory deadline, leading Plaintiff to seek judicial confirmation and enforcement of the IDR determination.
Procedural history
Plaintiff filed the complaint on August 20, 2025. Defendant moved to dismiss on October 20, 2025; Plaintiff opposed and filed a cross-motion to confirm the arbitration award; Defendant opposed the cross-motion and replied in support of dismissal. The court decided the motions on the papers without oral argument, granted Defendant's motion to dismiss, denied Plaintiff's cross-motion, and dismissed both claims.