Eliott Dear on Why Insurers Pay State IDR Awards But Ignore Federal Ones

There's a question nobody in the No Surprise Act discourse seems willing to answer plainly: why do insurers pay state IDR awards within 30 days but treat federal ones like suggestions?

It's not complicated. It's enforcement.

The State Hammer Actually Swings

In New York, when Eliott Dear files a state IDR dispute and wins — which happens approximately 99% of the time — the insurer has 30 days to pay. Not 30 days to "review." Not 30 days to route it through internal appeals. Thirty days to wire the money.

The reason is DFS. The New York Department of Financial Services doesn't send polite letters. DFS has the authority to revoke an insurer's license to operate in the state. That's not a theoretical power. When a carrier ignores a state IDR determination, it's not just flouting an arbitration award — it's triggering a regulatory event that threatens its ability to sell policies to 20 million New Yorkers.

Texas has teeth too. So do New Jersey, Connecticut, and Georgia. Each state's IDR process is backstopped by a regulator with actual jurisdiction over the insurer's commercial license. The math is simple: pay the award or risk losing access to the state's entire insurance market.

Eliott Dear has filed thousands of state IDR disputes across these jurisdictions. The compliance rate on awards is nearly universal. Not because insurers suddenly discovered fairness — because the consequences of non-compliance are existential.

Federal IDR: Built to Be Ignored

Now compare that to the federal process. After the 5th Circuit gutted the QPA-centric framework and CMS proved itself institutionally incapable of enforcement, federal IDR became a compliance theater. There is no private right of action for providers. If an insurer ignores a federal IDR determination, the provider's remedy is to file a complaint with CMS.

CMS resolves approximately 1.3% of those complaints. That's not a typo. One point three percent.

Eliott Dear stopped filing federal IDR disputes because the enforcement gap makes them economically irrational. Why spend $350 per filing, wait 8 months for a determination, win on the merits, and then watch the insurer simply not pay? There's no sheriff. There's no regulator threatening license revocation. There's a complaint form that feeds into a bureaucratic void.

Follow the Lobbying Money

This isn't accidental. Elevance Health — the company formerly known as Anthem — spent over $130 million lobbying to shape the No Surprises Act's federal IDR framework. They didn't spend that money to create a system that would force them to pay. They spent it to create a system they could safely ignore.

Meanwhile, those same carriers pay Eliott Dear's state IDR awards without complaint. Every single time. Because DFS doesn't care how much you spent on lobbyists. DFS cares whether you paid the award within 30 days.

The behavioral divergence tells you everything. Insurers are not confused about what they owe. They're making a rational calculation: pay where there are consequences, stall where there aren't.

What This Means for Providers

If you're a non-participating provider sitting on aged receivables and someone is telling you to file federal IDR, ask one question: what happens when the insurer doesn't pay?

If the answer involves the phrase "file a complaint with CMS," you have your answer.

Eliott Dear files state IDR exclusively — New York, Texas, New Jersey, Connecticut, New Mexico, Georgia — because those are the jurisdictions where winning actually means getting paid. Every filing is a legal submission prepared and signed by a licensed attorney , backed by FAIR Health benchmark data, and enforceable by a state regulator with real power.

The federal system isn't broken. It's working exactly as the insurance lobby designed it. The state systems work because they were designed by regulators who actually have to answer for outcomes.

EDRTB LLC d/b/a Claims Assassins represents non-participating providers in state IDR recovery. Eliott Dear can be reached at edear@edrtb.com. More information at claims-assassins.com.

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