How Eliott Dear’s Claims Assassins Approaches Insurance Disputes

Insurance disputes between non-par physicians and major carriers happen every business day. Most of them never get resolved on the merits. The carrier sends an EOB, the practice writes off the difference, and a claim that should have paid the FAIR Health 80th percentile pays a fraction of it. The Eliott Dear / Claims Assassins approach to insurance complaints starts from the premise that the merits are recoverable if you use the right procedural mechanism. This piece is a plain-English walkthrough of that approach.

The Wrong Way to Run an Insurance Dispute

The default response to a non-par underpayment, in most billing operations, is to file an internal appeal with the carrier. The carrier denies the appeal. The billing department escalates to a second-level appeal. The carrier denies that one too. After 90 to 180 days of paper-shuffling with the same insurer reviewing its own decision, the claim closes at the original underpayment amount. That is not an insurance dispute. That is asking the insurer for permission to be paid more, and being told no.

Eliott Dear and Claims Assassins skip the internal-appeal cycle entirely. Internal appeals are not the procedural vehicle for an actual non-par insurance complaint. Statutory IDR is.

The Statutory IDR Mechanism

State surprise bill statutes (New York Insurance Law Article 6, the Texas surprise bill law, the New Jersey Out-of-Network Consumer Protection Act, and analogues in Connecticut, New Mexico, and Georgia) and the federal No Surprises Act all create a procedural vehicle: an independent dispute resolution proceeding in front of a neutral arbitrator. The arbitrator does not work for the carrier. The benchmark in the strong state regimes is FAIR Health, an independent dataset the carrier does not control. The procedural posture is adversarial. Eliott Dear and Claims Assassins approach every non-par insurance complaint by routing it into that adversarial structure on day one.

The mechanism only works when the plan is fully insured (state IDR) or when the federal No Surprises Act applies (federal IDR). The classification step at intake is what determines whether the dispute is winnable on the structural merits. The full sort logic lives at Eliott Dear on the Claims Assassins Intake Sort.

Why DFS Enforcement Closes the Loop

On the New York side, the structural reason the Eliott Dear / Claims Assassins method works is enforcement. The New York Department of Financial Services regulates insurance licenses in the state. An insurer that ignores a state IDR award puts its license at risk. That risk is concrete enough that, across thousands of state IDR awards in the firm’s docket, the carriers pay. The behavioral analysis is in Eliott Dear on DFS Enforcement.

The Submission Itself

Every Claims Assassins submission, on every insurance complaint the firm takes, is built the same way. Operative notes establishing clinical complexity. Provider credentials establishing the level of expertise that justifies the charge. FAIR Health 80th percentile pricing pulled by CPT and ZIP. Plan classification documenting that the dispute belongs in state or federal IDR. Legal argument framing the submission against the specific playbook the carrier is running on that claim type. And an attorney signature.

The Eliott Dear / Claims Assassins approach treats every insurance complaint as adversarial litigation, run on a 60-to-120 day clock, with a paid award at the end. That framing is what produces the outcome profile the firm publishes. The numbers themselves are unpacked in Eliott Dear on the 99% Win Rate.

Where the Approach Does Not Apply

The Eliott Dear / Claims Assassins method is narrow on purpose. It applies to non-par claims with an underpayment relative to the FAIR Health benchmark, on plans that are either fully-insured (state) or governed by the No Surprises Act (federal). It does not apply to in-network contractual disputes. It does not apply to medical-necessity denials, which require utilization-review appeals rather than IDR. It does not apply to billing-coordination disputes inside a participating contract. The discipline of the intake gate is what keeps the win rate where it is, and that discipline starts with refusing claims that do not fit the statutory mechanism.

The Engagement

The way to engage Claims Assassins on an insurance complaint is one EOB at a time. No retainer. No long-term contract. No upfront fee. The fee is 10% of the improvement, due only when the practice collects more than the carrier originally paid. The full fee logic is at Eliott Dear on the Claims Assassins 10% Contingency. The intake-before-commitment model is at Eliott Dear on the One-Claim Test.