In Plastic & Reconstructive Surgery Group v. Aetna, Inc., the U.S. District Court for the District of Connecticut addressed a motion filed by petitioner Plastic & Reconstructive Surgery Group to allow discovery of the reasons behind the decision reached by the arbitrator in the underlying arbitration proceeding.
The underlying arbitration involved claims brought by various medical providers that provided out-of-network services to the respondent health insurance companies, including Aetna. The arbitration was brought by the petitioners pursuant to an independent dispute resolution (IDR) process established in the No Surprises Act (NSA) to “resolve disputes between insurers and providers over reimbursement rates.” If the matter cannot be resolved, the IDR process is initiated and a certified IDR entity (CIDRE) is appointed to determine if the IDR process is proper and, if so, the amount the insurer owes the medical service provider. The petitioners brought a claim disputing the reimbursement rate for certain medical services and respondent ProPeer was selected as the CIDRE arbitrator. After an arbitration, ProPeer “selected the insurers as the prevailing parties … and found $0.00 to be the appropriate out-of-network rate for the provided services.”
The petitioners then commenced an action in federal court under the NSA and the Federal Arbitration Act to vacate the arbitration award, contending that ProPeer exceeded its arbitration powers under the NSA. The petitioners filed a motion to compel discovery “to inquire into the reasoning behind ProPeer’s determinations of the IDR disputes.” The respondents opposed the motion, arguing that discovery from an arbitrator is only available when there is “clear evidence of impropriety” not present in this case. The district court agreed with the respondents, finding that the petitioners had not established “clear evidence” of impropriety by the arbitrator, and denied the petitioners’ motion for discovery.
Plastic & Reconstructive Surgery Group v. Aetna Inc., No. 3:25-cv-00211 (D. Conn. Dec. 31, 2025).
