Why IDR Awards Still Don’t Guarantee Payment and What Plan Sponsors Should Take Away
A recent decision from the U.S. District Court for the District of New Jersey reinforces a message plan sponsors have been hearing with increasing frequency: the No Surprises Act (NSA) created a payment framework without a reliable enforcement mechanism.
The aequum team closely monitors litigation and regulatory developments under the NSA to help self-insured plan sponsors and their third-party administrators better understand how these decisions affect real-world plan administration.
This note offers an update on emerging legal decisions – intending to offer practical (not legal) guidance for plan sponsors who must navigate the continuously evolving enforcement landscape.
In Freeman Pain Institute v. Horizon Blue Cross Blue Shield of New Jersey, the court dismissed a provider’s attempt to enforce an Independent Dispute Resolution (IDR) award after the insurer allegedly failed to pay the full amount within the NSA’s 30-day deadline. The ruling follows the same path as the Fifth Circuit’s Guardian Flight decision and confirms a growing judicial consensus. Courts are not going to step in to enforce IDR awards.
For plan sponsors, this decision is less about who won and more about what it reveals. The enforcement gap under the NSA is real, and it creates both risk and responsibility for self-insured plans.
What the Court Decided
The provider argued that the IDR decision should be enforced like an arbitration award under the Federal Arbitration Act. The court rejected that approach outright.
The IDR process under the NSA is not a voluntary arbitration agreement between two parties. It is a statutory mechanism imposed by federal law. Because there is no written arbitration agreement between a provider and the health plan, the FAA does not apply. More importantly, the court held that the NSA itself does not create a private right of action for providers to confirm or enforce IDR awards in federal court.
In plain terms, even if an IDR entity issues an award and even if the payment deadline passes, providers cannot sue to force payment. Enforcement is not judicial.
The Bigger Signal from the Courts
The New Jersey decision reinforces a broader trend. Courts are reading the NSA narrowly and refusing to expand enforcement beyond what Congress explicitly authorized. Here, Congress has not included any enforcement mechanism. Even where payment obligations are clear, judges are declining to act as backstops.
That leaves plan sponsors operating in a system where:
• IDR awards exist without guaranteed judicial enforcement.
• Providers continue to test the boundaries through aggressive billing and collections.
This is not a theoretical risk. It is a structural one.
Where aequum Fits
This is exactly the environment aequum was built for.
aequum operates in the space between statutory intent and real-world execution. When enforcement is fragmented and slow, plans still need to be protected. IDR outcomes still need to be managed correctly. Deadlines still matter. Documentation still needs to withstand scrutiny.
aequum supports plan sponsors by:
• Monitoring NSA and IDR timelines to prevent compliance breakdowns.
• Coordinating with administrators to ensure awards are executed correctly.
• Defending reimbursement positions when disputes escalate.
• Identifying provider conduct that creates regulatory or fiduciary exposure.
• Preserving the plan’s position when enforcement questions arise.
Courts may not enforce IDR awards, but regulators may try to enforce compliance (even where they have no authority). aequum helps ensure plans are prepared for that reality.
What Employers Should Do Now
The takeaway from the New Jersey decision is not comfort. It is clarity.
The NSA did not eliminate disputes. It reshaped where and how they are to be resolved. Plan sponsors who assume the system will police itself are taking on unnecessary risk. Those who actively oversee compliance and engage experienced advocacy partners are better positioned to defend their plans and protect participants. aequum helps plans do exactly that.
Contact aequum today if you are evaluating your NSA processes, IDR execution or administrative oversight. Now is the time to take a closer look. Enforcement may not come through the courts … but IT IS COMING!