Recently, the U.S. District Court for the Southern District of New York ruled in favor of emergency physician Dr. William A. Kennedy III in his case against UnitedHealthcare. The case, Kennedy v. UnitedHealth Group, Inc., centered around a critical question: Does the federal No Surprises Act (NSA) prevent out-of-network providers from suing insurers over unpaid emergency medical services? The answer was “no.”

Since going into effect in January 2022, the NSA has required that insurers who cover emergency services bill plan holders no more than the median in-network rate for a particular service, even if the provider is out-of-network; ensuring that most emergency care is covered as if it were in-network without any requirement for prior authorization.  Therefore, when UnitedHealthcare refused to pay for care rendered to its members, Dr. Kennedy and his group sued.

Dr. Kennedy specifically argued that he was required by federal and state law to provide emergency medical treatment which resulted in unjust enrichment when United Healthcare refused to pay. UnitedHealthcare argued that the doctor’s claims were barred from state court because the NSA, a federal law, created an “exclusive remedy” for such matters.

Ultimately, Judge Paul Engelmayer determined that while the NSA protects patients from surprise billing, it does not strip providers of their ability to bring state-level claims when insurers deny payment.

Considering this case, others like it, and ongoing regulatory updates, it is important providers and insurers stay informed and seek legal guidance when questions arise. You can find additional background information in the Campanella Law Office Blog:

• No Surprises Act: What Providers Should Know About the New Patient Protection Legislation
• No Surprises Act: Treasury Issues Final Rules in Continued Effort to Prevent Surprise Billing for Medical Care

(This blog, prepared by Campanella Law Office, is for general informational purposes only and is not intended to convey specific legal advice, nor is it intended to create or constitute an attorney-client relationship.)