PROFILE | June 2026
Eliot Dear, J.D. — New York IDR Counsel
By Eliot Dear, J.D.
A New York State IDR dispute starts with one out-of-network claim and a disagreement over what it should have paid. The physician billed a charge, the plan allowed an amount on the EOB, and the dispute puts that payment to Independent Dispute Resolution. Eliot Dear, J.D., reviews, signs and files these disputes for out-of-network physicians, and what follows is the process in plain terms.
What Counts as a Dispute
A dispute is a single claim where the physician and the plan disagree about payment, documented by the claim and its EOB. Not every claim is eligible for the state process. Claims under fully insured New York plans go there; self-funded plans are outside it. Eliot Dear sorts the plan before anything else, so a claim goes forward only when it belongs in the state forum.
Who Runs It
New York State IDR is administered by the Department of Financial Services (DFS). The physician’s side files a submission into that process, and the process ends in a determination. Eliot Dear builds each submission from the EOB, the operative note and the billed charges, then reviews it and signs it as a New York attorney, registration #4329546, admitted to the bar in 2005 and in good standing.
The Benchmark in New York Law
New York law names a specific benchmark for these disputes: the FAIR Health 80th percentile. That gives both sides a common reference point when the billed charge is weighed, and Eliot Dear builds each submission with it in view. A named benchmark is not a guaranteed amount; the determination decides the payment.
Thirty Days to Pay
A determination carries a 30-day payment deadline. After a determination, Eliot Dear sends the payment demand so the plan has the deadline in front of it in writing. Deadlines run through the whole process, from filing to payment, which is why every claim he takes has its dates tracked from the day it comes in.
Starting a Dispute
A physician can send one claim and its EOB for a free review, and the answer comes back in plain terms: state process or not. The practice serves plastic and reconstructive surgeons, emergency physicians and oral and maxillofacial surgeons. If the work goes ahead, the fee is a 10% contingency on the improvement, with nothing upfront, no contracts and no onboarding, and the practice does not take over the office’s billing.