A New York state court has dismissed a lawsuit brought by two medical practices seeking more than $1.7 million from Elevance Health subsidiaries over unpaid No Surprises Act arbitration awards, ruling that the providers failed to make a viable claim under state law.
Suffolk County Supreme Court Justice Paul Hennings granted the insurer’s motion to dismiss Sept. 17, throwing out all seven claims brought by True North Medical of Manhasset and True North Medical of Suffolk against four Anthem companies.
The two Long Island practices provided out-of-network care to members of Anthem-administered health plans. After disputing certain payment amounts, the providers took their claims through the independent dispute resolution process and won 13 determinations totaling more than $1.7 million, which they alleged Anthem did not pay.
Rather than filing under the No Surprises Act itself, the practices brought claims under New York state law, including unjust enrichment, violation of New York’s Prompt Pay statute, implied contract, insurance bad faith and declaratory judgment. They argued the IDR awards established what they were owed and that state law independently allowed them to collect.
The court found that every claim depended on the IDR determinations for both the obligation to pay and the dollar amount owed. The No Surprises Act does not create a private right of action to enforce those awards, and state-law claims cannot fill the gap when the underlying payment obligation comes entirely from the federal process.
“The submission of claims, receipt of partial payments, and participation in the NSA process reflect defendants’ administration of insurance benefits and compliance with federal law, rather than a meeting of the minds,” Justice Hennings wrote.
The court also rejected the providers’ Prompt Pay claim, finding the complaint did not identify the patients, insurance policies, claim submission dates or payment deadlines at issue.
An Anthem spokesperson told Becker’s the ruling is significant because it addresses the next phase of IDR-related litigation, with the Fifth Circuit ruling in June 2025 that the No Surprises Act does not grant providers a private right of action to enforce IDR awards in court.
Separately, air ambulance operator PHI Health sued Anthem in September, alleging the insurer refused to pay more than 1,200 IDR determinations totaling roughly $30 million nationwide. Federal judges in California and Georgia this year also dismissed with prejudice lawsuits in which Anthem subsidiaries accused providers of exploiting the IDR process, with courts ruling the suits amounted to improper attacks on arbitration outcomes.
Providers have won roughly 85% of resolved IDR cases, and dispute volume rose 77% from 2024 to 2025, according to an analysis published in Health Affairs.
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