Tamagnini v. Horizon Blue Cross Blue Shield of New Jersey

Summary

The District Court for the District of New Jersey granted Horizon Blue Cross Blue Shield of New Jersey’s unopposed Rule 12(b)(6) motion to dismiss a complaint seeking confirmation and enforcement of No Surprises Act independent dispute resolution determinations. The court held that the statutory IDR process was not an arbitration eligible for confirmation under Section 9 of the Federal Arbitration Act because the parties had no written arbitration agreement. The court further held that the No Surprises Act does not create an express or implied private right of action to judicially enforce IDR awards and instead provides an administrative enforcement scheme.

Holdings

1. The court lacks jurisdiction to confirm the IDR determinations under FAA § 9 because the statutory IDR process is not an arbitration governed by the FAA and the parties had no written agreement to arbitrate.
2. The No Surprises Act does not create an express or implied private right of action allowing a provider to seek judicial confirmation or enforcement of an IDR determination. The statute limits judicial review to the specified FAA § 10(a) vacatur circumstances and provides an administrative enforcement scheme instead.

Questions Presented

1. Whether an independent dispute resolution determination issued under the No Surprises Act may be confirmed and enforced under § 9 of the Federal Arbitration Act absent a written agreement between the provider and insurer to arbitrate.
2. Whether the No Surprises Act creates an express or implied private right of action permitting a provider to obtain judicial confirmation or enforcement of an IDR determination.
3. Whether the complaint stated a claim for relief under the FAA or the No Surprises Act.

Disposition

dismissed