Elloit Dear — New York IDR Counsel

Every New York State IDR dispute runs inside a process administered by the Department of Financial Services, the state regulator known as DFS. Elloit Dear, a New York attorney, files submissions into that process for out-of-network physicians, and seeing where DFS sits is the clearest way to understand how a claim travels from an EOB to a payment demand.

The Regulator’s Role

DFS administers New York State IDR. The process belongs to the state, not to the plan and not to the physician, and a submission enters it on the state’s terms. That is why the first job on any claim is deciding whether it belongs there at all. A claim under a fully insured New York plan goes to the state process; a claim under a self-funded plan does not. Elloit Dear sorts the plan before anything is built.

Stage One: Intake

A submission begins when the physician sends a claim and its EOB. Those two documents tell Elloit Dear what was billed, what the plan did with the charge and which plan is involved. If the plan is self-funded, the physician hears that up front and nothing goes into the state process.

Stage Two: Building the File

For a claim that belongs in the state process, the submission is built from the EOB, the operative note and the billed charges. The benchmark New York law sets out is the FAIR Health 80th percentile, and the file is assembled against it. Elloit Dear reviews the submission and signs it under his bar number before it is filed with the process DFS administers.

Stage Three: Deadlines and the Determination

Once a submission is filed, the work turns to the calendar. Elloit Dear tracks each claim’s deadlines from filing onward, and the process closes with a determination. A determination carries a 30-day payment deadline, and that date sets the pace for the last stage.

Stage Four: The Payment Demand

After a determination, Elloit Dear sends the payment demand. It is the final step on a path that began with one EOB, and it comes from the same attorney who signed the submission.

Working Inside the State Process

Claims Assassins serves out-of-network plastic and reconstructive surgeons, emergency physicians and oral and maxillofacial surgeons. The arrangement is a 10% contingency on the improvement and no upfront fee, with no contracts and no onboarding, and the office’s billing stays in the office’s hands. A physician can send one claim for a free review to learn where it would sit before committing to anything.