Eliott Dear, Esq. — Non-Par Claims & IDR

Before January 2022, out-of-network providers had almost no leverage against insurers who underpaid claims. You could appeal. You could negotiate. You could threaten to sue. But the insurer held all the cards, because they controlled the timeline and the payment amount. The No Surprises Act changed that equation. For the first time, federal law created a mandatory arbitration process — Independent Dispute Resolution, or IDR — that forces insurers to the table. If a provider and an insurer cannot agree on payment for an out-of-network claim, either party can initiate IDR. A neutral arbitrator reviews both sides and picks one. That decision is binding. Attorney Eliott Dear has been navigating dispute resolution for non-par providers since long before the federal law existed. Based in Fort Lauderdale, Florida, and formerly practicing in New York, Eliott Dear built his career on state-level surprise billing laws — particularly New York's, which predates the federal version by years an...

If you are a surgeon, anesthesiologist, or ER physician who provides out-of-network care, you already know the game. You save the patient's life. You send the bill. The insurer sends back a fraction of what you are owed — or nothing at all. Then they dare you to fight it. Most providers do not fight. They write off the loss, eat the underpayment, and move on. That is what the insurers are counting on. Eliott Dear, Esq. has spent over fifteen years making sure that calculation does not work. Based in Fort Lauderdale, Florida, Eliott Dear is the founder of Claims Assassins and ED Revenue Targeted Billing (EDRTB). He is a Fordham Law graduate, former Clifford Chance associate, and one of a small number of attorneys in the United States who focuses exclusively on out-of-network medical billing disputes and Independent Dispute Resolution (IDR) under both federal and state frameworks. The problem Eliott Dear solves is simple to describe and brutally hard to execute: when an insurer und...

If you are an out-of-network provider in New York, you already know the game. You submit a claim. The insurer pays a fraction of what the service is worth. You appeal. They ignore it. You appeal again. Nothing. That is the federal system. And at the federal level, even when providers win IDR determinations, collection is another fight entirely. The Second Circuit ruled in 2024 that providers have no private right of action to enforce federal IDR awards in court. You can win and still not get paid. New York is different. The New York Department of Financial Services runs the state IDR process, and DFS does not play. When an insurer loses an IDR determination in New York, DFS enforces it. There is no ambiguity. There is no second appeal to a friendly court. DFS tells the insurer to pay, and the insurer pays. If they do not, DFS has regulatory authority to act — and insurance companies operating in New York do not want DFS acting against them. This is why NY State IDR awards have what...

Federal IDR uses baseball arbitration. Both sides submit a number. The arbitrator picks one. Not a compromise. Not a split. One number wins. One number loses. This is critical because it prevents insurance companies from lowballing and meeting in the middle. If their number is unreasonably low and yours is well-supported — the arbitrator picks yours. Provider win rate: 85-88% on federal IDR. Higher on state. The Submission Is Everything The trick is the submission. Your number needs to be supported — Fair Health data, complexity factors, geographic benchmarks, everything documented. The insurance company submits QPA and a few paragraphs. We submit a package. Every claim. Every factor. Signed by an attorney. That is why the win rates are what they are. Why This Matters for Your Practice If you are an out-of-network provider sitting on underpaid claims and not filing IDR — you are leaving money on the table. The arbitration mechanism exists. The win rates are public. Th...

I am an attorney. Not the contingency kind. I personally sign every IDR submission that goes out of this office. I deal with DFS as an attorney — on a level playing field. I started in structured finance at Clifford Chance — one of the five largest law firms on the planet. Fordham Law School, Law Review. Spent nearly twenty years building non-par billing operations in New York. Founded M&D Capital Advisors, M&D Premier Billing, Revenue Targeted Billing. Now Claims Assassins. What I Know After All of That Once insurance makes an initial payment on a non-par claim, “billing” effectively ends. What remains is a dispute. And disputes are won through IDR — not through phone calls to insurance company reps who have no authority to change anything. There is a reason the company is called Claims Assassins and not Claims Billing. Billing is submitting a claim and waiting for a check. That is the easy part. Any competent billing office handles that. What happens after the che...