DFS Enforcement — Why NY State IDR Awards Have a 100% Collection Rate

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 is effectively a 100% collection rate. It is not because insurers voluntarily comply out of fairness. It is because DFS stands behind every determination with the full weight of state regulatory enforcement. An insurer that refuses to honor a DFS IDR award is not just stiffing a provider — it is defying its regulator. How the NY State IDR Process Works New York Insurance Law and the implementing regulations under 11 NYCRR Part 410 created an independent dispute resolution process specifically for out-of-network claim disputes. The process applies to emergency services, surprise bills, and other non-par situations where the provider and insurer cannot agree on reimbursement. Here is the key difference from the federal process: DFS administers and enforces the determination. The insurer does not get to relitigate. The insurer does not get to file a motion. The insurer does not get to shop for a favorable jurisdiction. DFS issues a binding determination, and payment follows. Why This Matters for Non-Par Providers If you are a surgeon, an ER physician, an anesthesiologist, or any specialist providing non-par services in New York — you are leaving money on the table if you are not filing state IDR. The economics are simple: the insurer underpays, you file with DFS, an independent reviewer determines the correct amount, and DFS makes the insurer pay it. Most providers do not file because they do not know the process exists, or because they assume that IDR is the same broken federal system where winning does not mean collecting. In New York, winning means collecting. DFS ensures it. What Claims Assassins Does I am Eliott Dear, an attorney who has spent nearly two decades in non-par medical billing. I graduated Fordham Law School on the Law Review, spent four years in structured finance at Clifford Chance, and then built billing operations from scratch — not as a consultant, but as an operator. I have run non-par claims for plastic surgeons and ER physicians across the New York metro area. Claims Assassins files IDR — both federal and state — for out-of-network providers. I personally sign every DFS submission. I deal with DFS as an attorney on a level playing field, not through a third party, not through outside counsel. When your claim goes to state IDR, I handle it from filing to collection. If you have non-par claims in New York that were paid below what they are worth — and you know they were — send me one recent claim. No contract. No commitment. If I cannot improve the outcome, there is no fee. That is the offer. Eliott Dear, Esq. Founder, Claims Assassins (EDRTB LLC) 646-387-9133 | edear@edrtb.com www.claims-assassins.com