T.V. Seshan, M.D., P.C. v. Aetna, Inc.

CourtDistrict Court, S.D. New York
DecidedMarch 30, 2026
Docket7:25-cv-02938
StatusUnknown

This text of T.V. Seshan, M.D., P.C. v. Aetna, Inc. (T.V. Seshan, M.D., P.C. v. Aetna, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
T.V. Seshan, M.D., P.C. v. Aetna, Inc., (S.D.N.Y. 2026).

Opinion

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK T.V. SESHAN, M.D., P.C., Plaintiff, -against- 25-CV-2938 (JGLC) AETNA, INC., OPINION AND ORDER Defendant.

JESSICA G. L. CLARKE, United States District Judge: The No Surprises Act (“NSA”) changed the trajectory of medical billing in the United States. In protecting patients from qualified surprise medical bills, the Act shifted the cost of certain out-of-network services onto health care providers and insurers. Before the Court today is whether Congress intended to create a privately enforceable remedy to accompany the NSA’s dispute resolution mechanism. In this case, like so many others around the country, a health care provider took care of a patient insured by a private company without a network contract. When the provider and insurer could not work out a fair cost-sharing agreement, they went to an arbitration-like forum to determine who should pay what. The health care provider won, and the insurer was directed to pay an award. But a 30-day statutory period passed, and the health insurer did not pay. Now, two-and-a-half years after Plaintiff provided its services, the insurer—here, Aetna—has only paid approximately 1% of what it owes. This case addresses what remedies, if any, parties to Independent Dispute Resolution (“IDR”) have to enforce the award rendered

therein. Ultimately, the Court finds that the NSA denies Plaintiff a remedy in federal court and dismisses the case. BACKGROUND Congress passed the No Surprises Act to prevent health care providers from sending patients surprise medical bills, often numbering in the tens of thousands of dollars, for out-of- network care they unknowingly received. “These unexpected medical bills can result in financial

ruin,” Congress recognized. H.R. Rep. No. 116-615, pt 1., at 52 (2020). The NSA was designed to protect privately insured patients from these unexpected costs by prohibiting “balance billing” in certain circumstances. See 42 U.S.C. §§ 300gg-131 to 132, 135. It requires insurers to cover emergency services at out-of-network facilities without prior authorization and certain out-of- network services at in-network facilities, and in turn, incentivizes this coverage by benchmarking rates comparable to those charged by in-network providers subject to an existing contract. 42 U.S.C. §§ 300gg-111(a)(1), (b)(1); see also id. § 300gg-111(a)(3)(E). In so doing, the Act set out accomplishing twin aims: protecting patients from unexpected, financially ruinous medical bills, and curtailing the rising costs of out-of-network treatment. See Letter from Frank Pallone and Patty Murray to Departments of Health and Human Services, Treasury, and Labor, at 1 (Oct. 20,

2021), https://www.help.senate.gov/imo/media/doc/Pallone%20Murray%20No%20Surprises%20Act%2 0IFR%20Comment%20Ltr%2010.20.212.pdf; see also NSA, Pub. L. No. 116-260, 134 Stat. 2859–60 (2020) (requiring study of the NSA’s impact on “overall health care costs” and “on premiums and out-of-pocket costs”). Because the NSA shifts the cost of some out-of-network care away from patients, it created a system for health care providers and private insurers to determine fair cost sharing. After providing a qualified out-of-network service for an insured patient, the health care provider sends a bill for the cost of the medical service to the applicable insurer. The insurer responds with an initial payment or notice of denial of payment. See 42 U.S.C. § 300gg-131(b)(1)(C). The provider may then, within 30 days, initiate open negotiations to seek a more desirable cost- sharing arrangement for the service or item. Id. § 300gg-111(c)(1)(A). Where negotiations are unsuccessful after 30 days, either party may initiate the IDR process to resolve the dispute. Id. §

300gg-111(c)(1)(B). The IDR process is “‘baseball-style’ arbitration,” wherein each party submits a payment offer with supporting information, and the “IDR entity” chooses between the two offers. Id. § 300gg-111(c)(5)(A)–(B); H.R. Rep. No. 116-615, pt 1., at 56–57 (2020). Only certified IDR entities may determine the dispute, and the factors they may consider are carefully prescribed by the NSA and its implementing regulations. See 42 U.S.C. § 300gg-111(c)(5)(C)– (D). A team of neurologists brings this action under Section 9 of the Federal Arbitration Act (“FAA”) and the No Surprises Act to confirm an IDR award against health insurance company Aetna. ECF No. 1 (“Compl.”) ¶¶ 5, 7, 24, 30. On September 21, 2023, Dr. Melissa Balbuena- Root provided neuromonitoring services during a surgical procedure at White Plains Hospital. Id.

¶ 6. No network contract governed the required payment. Id. ¶ 10. Plaintiff submitted a Health Insurance Claim Form to Defendant for $11,132 to cover the cost of its services, but Defendant only paid $107. Id. ¶¶ 8–9. Plaintiff disputed that payment determination and, following failed negotiations, initiated “arbitration.” Id. ¶¶ 13–14. An “arbitrator” ruled in Plaintiff’s favor and awarded Plaintiff $9,178 for its services. Id. ¶16. However, Defendant never paid, and Plaintiff brought suit. See id. ¶¶ 19–21. Plaintiff brings two alternative claims in this action. First, Plaintiff seeks an order confirming the award against Defendant under 9 U.S.C. § 9 (“Section 9 of the FAA”). Id. ¶¶ 23– 28. Second, Plaintiff brings a claim under the NSA, claiming that Defendant, by failing to make the ordered payment within 30 days, violated the Act. Id. ¶¶ 29–36. Plaintiff seeks an order directing Defendant to pay the outstanding $9,071, plus attorneys’ fees and costs for the instant action. Id. at 6. The parties dispute whether the NSA contains a private right of action and whether Plaintiff can seek relief under Section 9 of the FAA. See ECF No. 13 (“MCA”); ECF

No. 14 (“Opp. to MCA”). Defendant also contends Plaintiff brought this action against the wrong party. Opp. to MCA at 6–7. The facts are largely undisputed in this case, leaving it ripe for the Court’s determination. DISCUSSION The following discussion proceeds in three parts. First, the Court analyzes whether the No Surprises Act contains an implied right of action that would enable Plaintiff to bring the present case and finds that it does not. Second, the Court determines that Plaintiff similarly cannot obtain relief under Section 9 of the FAA, because the NSA forecloses that claim. And third, the Court concludes that the parties’ remaining arguments are moot in light of its prior determinations.

At the outset, the Court notes that it properly has subject matter jurisdiction in this matter—an issue that the Court asked the parties to brief. See ECF No. 9. Where a complaint “is so drawn as to seek recovery directly under the Constitution or laws of the United States,” the district court must entertain the suit unless the federal claim “clearly appears to be immaterial and made solely for the purpose of obtaining jurisdiction or where such a claim is wholly insubstantial and frivolous.”

Chenkin v. 808 Columbus LLC, 368 F. App’x 162, 163 (2d Cir. 2010) (quoting Bell v. Hood, 327 U.S. 678, 681–83 (1946)). Here, even though the Court finds that the NSA does not contain a private right of action, for the reasons stated below, the genuine question under the federal laws renders jurisdiction appropriate. See id.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Chenkin v. 808 Columbus LLC
368 F. App'x 162 (Second Circuit, 2010)
Bell v. Hood
327 U.S. 678 (Supreme Court, 1946)
United States v. Naftalin
441 U.S. 768 (Supreme Court, 1979)
Russello v. United States
464 U.S. 16 (Supreme Court, 1983)
United States v. Williams
553 U.S. 285 (Supreme Court, 2008)
Shahriar v. Smith & Wollensky Restaurant Group, Inc.
659 F.3d 234 (Second Circuit, 2011)
Lopez v. Jet Blue Airways
662 F.3d 593 (Second Circuit, 2011)
SRM Chemical Ltd. v. Federal Mediation & Conciliation Service
355 F. Supp. 2d 373 (District of Columbia, 2005)
Spray Drift Task Force v. Burlington Bio-Medical Corp.
429 F. Supp. 2d 49 (District of Columbia, 2006)
Cheminova A/S v. Griffin L.L.C.
182 F. Supp. 2d 68 (District of Columbia, 2002)
Alexander v. Sandoval
532 U.S. 275 (Supreme Court, 2001)
Non-Dietary Exposure Task Force v. Tagros Chemicals India, Ltd.
309 F.R.D. 66 (District of Columbia, 2015)
Kingdomware Technologies, Inc. v. United States
579 U.S. 162 (Supreme Court, 2016)
Georges v. United Nations
834 F.3d 88 (Second Circuit, 2016)
Seneca Nation of Indians v. State of New York
988 F.3d 618 (Second Circuit, 2021)
Badgerow v. Walters
596 U.S. 1 (Supreme Court, 2022)

Cite This Page — Counsel Stack

Bluebook (online)
T.V. Seshan, M.D., P.C. v. Aetna, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/tv-seshan-md-pc-v-aetna-inc-nysd-2026.