Eliott Dear — Physician Reimbursement Advocate

A dispute over an out-of-network payment starts with the paper the practice kept: the EOB, the operative note, the itemized bill and the dates that tie them together. Eliott Dear builds every Independent Dispute Resolution submission from those documents, so a practice that keeps them in order has already laid most of the groundwork.

The EOB: The Insurer’s Own Account

The explanation of benefits is the insurer’s statement of what it allowed and what it paid, and it is where every dispute begins, because it shows the gap between the billed charges and the payment. Eliott Dear reads it first to sort the plan: a fully insured New York plan belongs in New York State IDR, administered by the Department of Financial Services, while a self-funded plan sits outside the state process. Keep every EOB issued on the claim, including any reprocessed version, not only the first.

The Operative Note: What Was Done

The operative note is the surgeon’s own record of the procedure. An underpayment can treat a demanding procedure as if it were a routine one; the operative note is the document that describes the work actually performed, step by step. A submission without it asks the reviewer to take the bill on faith, so it belongs in the file from the start.

The Itemized Bill: What Was Charged

The billed charges are the other side of the comparison. An itemized bill, with each code and each charge on its own line, lets Eliott Dear set the charge against the payment line by line and against the benchmark New York law names, the FAIR Health 80th percentile. A single total at the bottom of a statement is not enough; the dispute is argued one line at a time.

The Dates: What Holds It Together

Dates connect the other three documents: the date of service, the date the claim went out, the date the EOB issued and the date any payment arrived. Deadlines in the process are tracked from those dates, and a file with blurry dates is a file that loses time. A determination carries a 30-day payment deadline, so its date matters as much as any other on the file.

Handing It Over

A practice does not need to reorganize its records to work with Eliott Dear. The billing office sends a claim and its EOB, and the rest is requested as the file is built. The terms are a 10% contingency on the improvement, no upfront fee, no contracts and no onboarding. Every submission is reviewed and signed by Eliott Dear under New York registration #4329546, and one claim can be sent for a free review.