Air ambulance operator PHI Health is suing Anthem Blue Cross and Blue Shield for allegedly refusing to pay tens of millions of dollars in binding arbitration awards issued under the No Surprises Act.
The complaint, filed Aug. 31 in the U.S. District Court for the Southern District of Indiana, names Anthem alongside more than two dozen large employers whose health plans are administered by the insurer, including General Motors, Kroger, Toyota Industries North America, and Franciscan Alliance. PHI alleges those plan sponsors, as ERISA fiduciaries, knew or should have known about Anthem’s alleged pattern of nonpayment and failed to take corrective action.
Under the No Surprises Act, the independent dispute resolution process helps settle payment disputes between out-of-network providers and insurers. A certified IDR entity reviews competing payment offers from both sides and selects one, with the resulting determination required to be paid within 30 days.
PHI is seeking more than $1.3 million in unpaid award balances connected to cases in Indiana; nationally, the company says Anthem has failed to pay more than 1,200 IDR determinations owed to it, totaling roughly $30 million.
The complaint describes what it calls a “low pay, late pay, or no pay” strategy designed to pressure providers into accepting below-market network rates or below-market reimbursement for out-of-network services rather than endure the administrative and financial burden of repeated arbitration proceedings. PHI alleges Anthem benefits financially from this approach by retaining and earning interest or investment income on funds that should have been paid to providers.
“The federal IDR process has clear eligibility requirements that all parties are expected to follow,” a spokesperson for Anthem told Becker’s. “We will continue to defend against these actions while supporting reforms that strengthen eligibility standards and ensure IDR remains focused on resolving appropriate out-of-network disputes.”
The IDR process faces mounting scrutiny as arbitration costs and dispute volumes have surged over the last year. A Wall Street Journal analysis of the latest CMS data put total arbitration awards at nearly $15 billion in 2025 alone, up from $4 billion the year prior. Congress is also weighing the bipartisan No Surprises Act Enforcement Act, which would impose stronger penalties on insurers and providers that miss payment deadlines after IDR determinations.
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