PHI Health, L.L.C. v. Custom Design Benefits, L.L.C.

CourtOhio Court of Appeals
DecidedJuly 8, 2026
DocketC-250606
StatusPublished

This text of PHI Health, L.L.C. v. Custom Design Benefits, L.L.C. (PHI Health, L.L.C. v. Custom Design Benefits, L.L.C.) is published on Counsel Stack Legal Research, covering Ohio Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
PHI Health, L.L.C. v. Custom Design Benefits, L.L.C., (Ohio Ct. App. 2026).

Opinion

[Cite as PHI Health, L.L.C. v. Custom Design Benefits, L.L.C., 2026-Ohio-2594.]

IN THE COURT OF APPEALS FIRST APPELLATE DISTRICT OF OHIO HAMILTON COUNTY, OHIO

PHI HEALTH, LLC, : APPEAL NO. C-250606 TRIAL NO. A-2502726 Plaintiff-Appellant, :

vs. :

CUSTOM DESIGN BENEFITS, LLC, : JUDGMENT ENTRY

and :

BOB SUMERAL TIRE COMPANY, LLC, :

Defendants-Appellees. :

This cause was heard upon the appeal, the record, and the briefs. For the reasons set forth in the Opinion filed this date, the judgment of the trial court is affirmed. Further, the court holds that there were reasonable grounds for this appeal, allows no penalty, and orders that costs be taxed under App.R. 24. The court further orders that (1) a copy of this Judgment with a copy of the Opinion attached constitutes the mandate, and (2) the mandate be sent to the trial court for execution under App.R. 27.

To the clerk: Enter upon the journal of the court on 7/8/2026 per order of the court.

By:_______________________ Administrative Judge [Cite as PHI Health, L.L.C. v. Custom Design Benefits, L.L.C., 2026-Ohio-2594.]

IN THE COURT OF APPEALS FIRST APPELLATE DISTRICT OF OHIO HAMILTON COUNTY, OHIO

PHI HEALTH, LLC, : APPEAL NO. C-250606 TRIAL NO. A-2502726 Plaintiff-Appellant, :

CUSTOM DESIGN BENEFITS, LLC, : OPINION

Civil Appeal From: Hamilton County Court of Common Pleas

Judgment Appealed From Is: Affirmed

Date of Judgment Entry on Appeal: July 8, 2026

Kegler, Brown, Hill + Ritter, and Matthew M. Zofchak, for Plaintiff-Appellant,

Young & Alexander Co., LPA, Jonathon L. Beck, AxePoint Law, and Ryan L. Woody, for Defendants-Appellees, [Cite as PHI Health, L.L.C. v. Custom Design Benefits, L.L.C., 2026-Ohio-2594.]

BOCK, Judge.

{¶1} This appeal involves plaintiff-appellant Phi Health, LLC’s, (“Phi

Health”) lawsuit to enforce two independent dispute resolution (“IDR”) awards

against defendants-appellees Custom Design Benefits, LLC, (“Custom Design”) and

Bob Sumeral Tires, LLC, (“Bob Sumeral”) in Phi Health’s favor.

{¶2} Phi Health argues that the trial court erred when it dismissed its

complaint after the trial court found that Phi Health lacked a private right of action to

enforce the IDR awards under the federal No Surprises Act, Federal Arbitration Act,

and the Ohio Arbitration Act.

{¶3} We hold that the No Surprises Act does not authorize private lawsuits

to enforce IDR awards. We also hold that an IDR award issued under the No Surprises

Act is not enforceable under federal and Ohio arbitration statutes.

{¶4} We overrule Phi Health’s assignments of error and affirm the trial

court’s judgment.

I. Factual and Procedural History

{¶5} Because this appeal involves a dismissal under Civ.R. 12(B)(6), we draw

the following facts from the complaint and accept them, with all reasonable inferences,

as true and construe them in Phi Health’s favor.

{¶6} Phi Health is an air ambulance company. In 2013, Phi Health

transported a patient who had health insurance coverage through his employer, Bob

Sumeral. Custom Design administered the policy. Phi Health, an out-of-network

provider, billed Custom Design $49,572 for a helicopter transport to a hospital and

$66,875 for the distance transported on a per-mile basis under Medicare codes A031 OHIO FIRST DISTRICT COURT OF APPEALS

and A036.1 Custom Design sent Phi Health an explanation of benefits, $5,107.35 for

the one-way helicopter transport, and $4,774 for the miles travelled.

{¶7} In 2024, Phi Health initiated the IDR process and prevailed after

Custom Design failed to submit offers. The IDR entity determined that “the out-of-

network payment amount of $38,556.16” was appropriate for the transportation and

“the out-of-network payment amount of $53,465” was appropriate for the distance.

{¶8} Custom Design did not pay the IDR awards. So, Phi Health filed an

“Application to Confirm Arbitration Award” in the trial court. Custom Design and Bob

Sumeral filed a joint motion to dismiss, arguing that Phi Health lacked a right of action

to enforce the IDR awards. The trial court, relying on Guardian Flight, L.L.C. v. Health

Care Ser. Corp., 140 F.4th 271 (5th Cir. 2025), cert. denied, ___U.S.___, 196 S.Ct.

1493 (2026), dismissed Phi Health’s complaint for lack of a private right of action.

II. Analysis

{¶9} On appeal, Phi Health raises three assignments of error. First, it

contends that the No Surprises Act provides a private right of action to enforce IDR

awards. Second, it argues that the trial court failed to consider whether Phi Health

could enforce the IDR awards under the Federal Arbitration Act (“FAA”), Ohio’s

Arbitration Act (“OAA”), or the common law. Third, it maintains that dismissal was

improper because it “plausibly alleged binding adjudicatory determinations, non-

payment, and resulting harm, and asserted multiple alternative theories of relief.”

{¶10} We review the trial court’s decision to grant a motion to dismiss de

novo. Plush v. City of Cincinnati, 2020-Ohio-6713, ¶ 12 (1st Dist.). We accept the facts

1 See Ctrs. for Medicare & Medicaid Servs., Medicare Claims Processing Manual, No. 100-04 Ch.

15 20.3, https://www.cms.gov/regulations-and-guidance/guidance/manuals/internet-only- manuals-ioms-items/cms018912 (accessed Mar. 27, 2026) [https://perma.cc/FWF8-7ST8].

4 OHIO FIRST DISTRICT COURT OF APPEALS

alleged in the complaint as true and will affirm the trial court’s dismissal if the plaintiff

failed to allege any facts that would entitle it to recovery. Id.

A. Private rights of action

{¶11} A “private right[] of action to enforce federal law must be created by

Congress.” Alexander v. Sandoval, 532 U.S. 275, 286 (2001). Indeed, not every

violation of federal law “‘give[s] rise to a private cause of action.’” Touche Ross & Co.

v. Redington, 442 U.S. 560, 568 (1979), quoting Cannon v. Univ. of Chicago, 441 U.S.

677, 688 (1979). A private right of action may be express or implied. See Anderson v.

Smith, 2011-Ohio-5619, ¶ 10 (10th Dist.). But absent an express private right of action,

“courts presume that Congress did not intend to create one.” Axis Neuromonitoring,

LLC v. Aetna Inc., 2026 U.S. Dist. LEXIS 61210, *13 (D.Conn. Mar. 20, 2026).

{¶12} Determining “whether a statute creates a cause of action, either

expressly or by implication, is basically a matter of statutory construction.”

Transamerica Mtge. Advisors (tama) v. Lewis, 444 U.S. 11, 15 (1979). Our “task is to

interpret the statute Congress has passed to determine whether it displays an intent

to create not just a private right but also a private remedy.” Alexander at 286.

{¶13} Issues of statutory interpretation present “a question of law that we

review de novo.” Greenacres Found. v. Bd. of Bldg. Appeals, 2012-Ohio-4784, ¶ 10

(1st Dist.). When reading a statute, we must “give full effect to the legislature’s intent.”

Walker v. Firelands Community Hosp., 2007-Ohio-871, ¶ 36 (6th Dist.). We “may not

delete words used or insert words not used.” Cincinnati Community Kollel v. Testa,

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Related

Cort v. Ash
422 U.S. 66 (Supreme Court, 1975)
Cannon v. University of Chicago
441 U.S. 677 (Supreme Court, 1979)
Touche Ross & Co. v. Redington
442 U.S. 560 (Supreme Court, 1979)
Transamerica Mortgage Advisors, Inc. v. Lewis
444 U.S. 11 (Supreme Court, 1979)
Russello v. United States
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Gustafson v. Alloyd Co.
513 U.S. 561 (Supreme Court, 1995)
Gutierrez v. Ada
528 U.S. 250 (Supreme Court, 2000)
Gonzaga University v. Doe
536 U.S. 273 (Supreme Court, 2002)
Alexander v. Sandoval
532 U.S. 275 (Supreme Court, 2001)
Cincinnati Community Kollel v. Testa
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Walker v. Firelands Community Hospital
869 N.E.2d 66 (Ohio Court of Appeals, 2007)
Plush v. Cincinnati
2020 Ohio 6713 (Ohio Court of Appeals, 2020)
O'Brien v. University Community Tenants Union, Inc.
327 N.E.2d 753 (Ohio Supreme Court, 1975)
Hernandez v. Mesa
589 U.S. 93 (Supreme Court, 2020)
Brendamour v. Indian Hill
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Guardian Flight v. Health Care Service
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