On occasion, people insured by a health plan may require emergency or non-emergency care, without the ability to consent to that care. One instance may be when the person is unconscious at the scene of an accident and has to be airlifted to a hospital. If the air lift service is not in network or not covered, an astronomically large bill may surprise the patient later. 

The Department of Labor calls that surprise billing. It explains, “Surprise billing occurs when you have health coverage and unknowingly or unavoidably receive care from an out-of-network provider or at an out-of-network healthcare facility and are billed directly for that care when your health plan does not cover the entire cost of care.” The No Surprises Act (NSA) is supposed to protect the patient in certain circumstances.

When the NSA applies, that can result in a dispute between the health care insurer and the provider. That occurred recently in the case Reach Air Med. Servs. LLC v. Kaiser Found. Health Plan Inc., No. 24-10135, 2025 LX 540030 (11th Cir. Nov. 19, 2025).  A patient insured by Kaiser Foundation Health Plan (Kaiser) required emergency air ambulance services. However, the provider Reach Air Medical Services, LLC (Reach) was not in Kaiser's network. Since the NSA applied, Kaiser and Reach attempted to negotiate payment of the service, but when that failed, they entered into the the Independent Dispute Resolution (IDR) process under the NSA. 

Before entering into this process Kaiser submitted an offer of $17,304.29.  However, in the IDR process it offered $24,813.48, while Reach submitted $52,474.60. The arbitrator selected Kaiser's offer.  Reach felt unfairly surprised by Kaiser's change in position. It further did not like  the arbitrator's allowance of that and then ruling in Kaiser's favor. 

Reach filed a lawsuit in district court. It claimed that Kaiser engaged in fraud in submitting a lowball offer before the IDR process and then raising the offer during IDR. It wanted the district court to vacate the arbitrator award.  The district court refused to do so and dismissed the case. Reach, still not content, appealed the matter. 

The 11^th Circuit affirmed.  It ruled that as a matter of law simply changing the pre-IDR offer to a higher amount during the IDR process was not grounds for vacation of the award. It noted that the Federal Arbitration Act (FAA) specifically encouraged each side to provide a reasonable offer rather than take an extreme position.  

The 11^th Circuit further noted that vacation of an arbitration decision occurs only in unusual circumstances as there is a presumption that arbitration awards will be confirmed. Those standards were not met here. In particular the court noted that there was no fraud pled with the particularity required. Absent pleading of specific time, place, and person representations that were false, a fraud claim is due to be dismissed.

This time, due to the No Surprises Act, the air ambulance provider was surprised rather than the patient or the health insurance carrier.  In arbitration, reasonableness more likely wins the day under the NSA.