Fifth Circuit Holds Air Ambulance Providers Did Not Have Standing to Bring ERISA Claim Against Health Insurance Company

In Guardian Flight, L.L.C. v. Health Care Serv. Corp., No. 24-10561, —F.4th—-, 2025 WL 1661358 (5th Cir. June 12, 2025), the Fifth Circuit Court of Appeals considered an appeal of the dismissal of Guardian Flight, LLC, and Med-Trans Corporation’s ERISA claim against Health Care Service Corporation (HCSC). The plaintiffs, air ambulance providers, alleged that HCSC improperly denied benefits to its beneficiaries by failing to pay them, which they argued violated the No Suprises Act (“NSA”) and ERISA. The court agreed with the district court that the NSA does not contain a private right of action, and because the Providers failed to allege a derivative claim under ERISA, or for quantum meruit under Texas law, the court affirmed the dismissal.

For healthcare providers to pursue a derivative ERISA claim, they must have a proper assignment of benefits from the plan beneficiaries. Here, while the Providers did have assignments, they failed to demonstrate that the beneficiaries suffered a concrete injury, which is essential for standing. The court emphasized that the NSA protects beneficiaries from liability for out-of-network coverage costs, negating any claim of injury.

The court found that since the NSA shields beneficiaries from additional financial liability, they sustained no actual harm. Thus, the Providers, despite having assignments, lack standing because their assignors—the beneficiaries—would not have standing to sue under ERISA on their own.

The court stressed that without any financial impact or risk to the beneficiaries due to HCSC’s actions, the plaintiffs could not prove an ERISA-related injury. The beneficiaries would not receive any additional benefits even if the lawsuit succeeded. Hence, there was no tangible stake in the litigation.

In summary, because the beneficiaries would lack Article III standing if they brought an ERISA claim on their own, the court held that the Providers lack standing to bring a derivative ERISA claim as their assignees.