INSURANCE-RELATED COURT CASES
Digested from case reports published online
COURT DECISIONS
Arbitration complaint was a swing and a miss
A person needed emergency help, which was provided by an air ambulance company called Reach Air Medical Services LLC (Reach). The patient was insured by a health maintenance organization by the name of Kaiser Foundation Health Plan Incorporated (Kaiser). The dispute that arose between Reach and Kaiser was a matter of billing.
As the patient’s transportation was an emergency, Reach’s service was the first to respond to the request, but it did not belong to Kaiser’s health provider network. The trip consisted of an 80-mile flight in a helicopter, especially fitted with ambulance equipment. The service included full medical care. Kaiser offered to pay Reach $24,813.48.
Reach insisted that the amount was an underpayment. After a period during which Kaiser and Reach argued without conclusion, they pursued Independent Dispute Resolution (IDR) as required by the Federal No Surprise Act (NSA). C2C Innovation Solutions Inc. (C2C) was assigned to handle the arbitration after Kaiser and Reach could not agree on an arbitrator.
Proceeding with the IDR, both Kaiser and Reach submitted payment requests to C2C for consideration. Later, when C2C selected Kaiser’s offer, Reach filed a lawsuit. C2C and Kaiser filed separate motions asking that Reach’s complaint be dismissed. After the court found in favor of C2C and Kaiser, Reach appealed.
The higher court took the matter anew. Reach continued its earlier allegation. It argued that Kaiser secured a favorable arbitration decision through undue means and misrepresentations. Specifically, Reach asserted that Kaiser used different qualifying payment amounts (QPA) before and after the IDR process began. Reach also requested that the IDR decision be vacated and demanded a new IDR.
Much of the court’s initial effort was to clarify its understanding of the laws and rules of the arbitration process used by Reach and Kaiser (and handled by C2C). Initially, Kaiser offered a payment of $24,813.48, stating that amount as the QPA. Under the IDR, Kaiser made a payment offer in the same amount but also advised the arbitrator that the QPA was around $17,300. Reach submitted a payment amount of $52,474.60.
Under the No Surprise Act, a baseball version of arbitration is used. Under this version, an arbitrator’s only discretion is to choose between the actual amounts submitted by the parties. In this case, C2C advised that its consideration of the two parties’ supporting information resulted in its choice of Kaiser’s offer of $24,813.48.
The higher court’s review quickly addressed the decision of the district court to dismiss Reach’s complaint. The court pointed out that there were no grounds to sue an IDR arbitrator except for narrow grounds that included evidence of fraud, corruption, impartiality, misconduct or exceeding their authority. In the court’s view, Reach did not present required evidence that the arbitrator made its decision outside of consideration of the offers and supporting information received from both parties. Neither fraud nor undue influence appeared at play.
Regarding possible misrepresentation, while Kaiser did indicate two different QPAs, the company maintained the same offer to Reach as its initial payment offer and as its arbitration offer. In the court’s view, as Kaiser provided all necessary arbitration offer support information, those figures did not influence the figure selected by the arbitrator. The court affirmed the decision of the district court, preserving C2C’s arbitration decision in favor of Kaiser.
Reach Air Medical Services LLC v. Kaiser Foundation Health Plan Inc., C2C Innovative Solutions, Inc.—United States Court of Appeals for the Eleventh Circuit—No. 24-10135—November 19, 2025.
