The No Surprises Act was passed in 2020 to end surprise medical billing — the practice of patients receiving enormous out-of-network bills they never agreed to, often from providers they didn’t choose. Emergency physicians. Anesthesiologists. Radiologists. The law created an Independent Dispute Resolution (IDR) process: when a provider and insurer can’t agree on a payment amount, a neutral arbitrator decides.
On April 9, 2026, the U.S. District Court for the Central District of California dismissed every claim Anthem Blue Cross brought against HaloMD, a company that manages out-of-network payment disputes on behalf of providers, without leave to amend. Anthem had thrown everything at this case. RICO. Fraud. ERISA. State law. It sought damages, vacatur of arbitration awards, and injunctive relief aimed at stopping future dispute submissions. The judge rejected all of it.
Anthem had alleged that HaloMD and affiliated providers submitted more than 1,500 IDR proceedings between January 2024 and August 2025, claiming roughly 47% were ineligible for arbitration. Judge Karen Scott ruled that the No Surprises Act limits judicial review of arbitration results and that the court cannot pass judgment even if Anthem believes the process is “deeply flawed.” If Anthem has policy complaints, the judge said, it should take them to Congress.
Within the same week, a federal district court in Florida dismissed Aetna’s nearly identical lawsuit against Radiology Partners. Two courts. One week. Same answer.
HOW IT AFFECTS PATIENTS
The No Surprises Act exists because patients were being financially destroyed by bills they had no warning about and no power to prevent. The IDR process is the enforcement mechanism that makes the law real. When insurers can tie up arbitration outcomes in years of federal litigation, they effectively nullify it.
Every provider that can’t afford to fight becomes a provider that accepts whatever the insurer offers, or exits the network entirely. Either way, patients lose access. Providers maintain that the IDR process exists to ensure fair reimbursement precisely because payers have used flawed, low-payment methodologies that force providers to seek arbitration in the first place. This ruling keeps that safety valve open.
WHAT IT MEANS FOR INSURANCE COMPANIES
Anthem is appealing. An Elevance spokesperson said the company believes the ruling “misinterprets the No Surprises Act and improperly limits judicial review.” That argument will now get a full hearing at the Ninth Circuit.
But the immediate signal is uncomfortable for payers. There are at least 13 similar insurer lawsuits against IDR middlemen and providers currently tracked across the country. All of them just got harder to win. Insurers built a litigation strategy around the idea that federal courts would be available to second-guess arbitration outcomes they disliked. Two courts in one week said no.
The volume problem is real. The IDR system has been flooded with far more disputes than Congress anticipated. But the solution runs through Congress and CMS, not through RICO claims in federal court.
WHAT IT MEANS FOR HEALTHCARE ORGANIZATIONS
HaloMD works on behalf of nearly 20,000 healthcare providers, who have delivered care and then been underpaid or denied payment entirely. For those organizations, this ruling is oxygen.
Independent physician groups have been squeezed for years between rising costs and stagnant reimbursements. The IDR process was supposed to be a backstop. If insurers can unwind arbitration wins through litigation, that backstop disappears and the pressure to consolidate, to sell practices to hospital systems or to the insurers themselves, intensifies.
HaloMD’s CEO put it plainly: Anthem’s lawsuit “was a calculated attempt to bully providers into accepting unsustainable rates, driving them toward consolidation under the very insurance companies that refused to pay them fairly in the first place.”
That is the stakes. Not just this case. The independence of healthcare organizations.
MY TAKE
Health care providers have watched insurers deny care for decades and it is getting worse. We have watched them write policies that sound reasonable until you actually need them. We have watched them fight every mechanism patients and providers have ever built to push back and we have watched them lose in court and immediately begin looking for another door.
Last week, a federal judge closed one of those doors. Firmly. And then, four days later, another judge closed the same door in Florida.
The No Surprises Act is working exactly the way Congress intended, which is precisely why insurers are in court trying to dismantle it. This ruling holds the line. But Anthem has already filed its appeal, similar cases are pending in Georgia, Ohio, and Texas, and the Ninth Circuit could reverse this entirely.
Watch the appeal. Tell your legislators that the IDR process needs to be strengthened, not litigated into irrelevance. And if you are a physician group or independent practice sitting on unpaid IDR awards, know that the courts, at least for now, are on your side.