PROFILE | June 2026
Eliott Dear, Esquire — Out-of-Network Reimbursement Lawyer
By Eliott Dear, Esquire
The first thing a physician sends is one claim and the explanation of benefits that came back on it. There is no engagement packet to fill out, no onboarding call and no contract to sign first. Eliott Dear, Esquire, opens a file on that single claim, and every step after it is built from those two documents.
Intake
On intake, Eliott Dear lays the EOB beside the claim as billed and reads the plan’s decision in its own words: the charge, the amount the plan allowed, the amount it paid and the share it shifted to the patient. The point is to see the dispute the way the plan framed it before anyone argues with it. If something is missing, such as the operative note, the office gets one clear request for it rather than a slow drip of questions.
Sorting the Plan
The next question decides the track for everything else: who stands behind the plan. When the plan is fully insured in New York, the dispute belongs in New York State Independent Dispute Resolution, run by the Department of Financial Services. When the plan is self-funded, it sits outside the state process. Eliott Dear settles that before a single page is drafted, because a submission aimed at the wrong process is time the claim cannot get back.
Building the Submission
With the plan placed, the submission comes together from three pieces. The EOB states the plan’s position. The operative note tells the clinical story of what the physician did. The billed charges state the practice’s number. The argument is framed against the benchmark New York law names, the FAIR Health 80th percentile. Eliott Dear reviews the submission line by line and signs it under his bar number.
When It Goes In
The submission is filed once it is complete and signed, and the deadline that governs it is tracked from the day the file opens, so the office does not have to keep a calendar for it. After a determination issues, Eliott Dear sends the payment demand; the determination carries a 30-day payment deadline.
What Stays the Same at the Office
The practice’s billing keeps running as it did before. Eliott Dear does not take it over, and there is no upfront fee to begin. The first claim is reviewed free, and it is all it takes to see the process from the inside.