Working with Attorney Eliott Dear: What to Expect on Out-of-Network Reimbursement

Physicians considering Claims Assassins almost always have the same threshold question. What is it actually like to work with attorney Eliott Dear on an out-of-network claim? This piece walks through the engagement, end to end, from the first EOB you send to the day a state IDR award lands in the practice account. It is written for the surgeon, ER physician, or non-par specialist who has never run a claim through statutory IDR and wants to know what the attorney does, what the practice does, and where the line sits between the two.

The First Conversation

Working with attorney Eliott Dear starts with a phone call. Not a sales call routed through a pipeline. The number you dial reaches the attorney directly, and that does not change after you sign on. Every Claims Assassins physician has Eliott Dear’s personal cell. The reasoning is in Eliott Dear on Direct Cell Access: when you have a question about a claim, you should be able to ask the lawyer who signed the filing.

The first call is short. Eliott Dear wants to know what specialty you practice, where you operate, what your typical non-par mix looks like, and which carriers you see most often. The point of that conversation is not to sell. It is to figure out whether the structural pattern of your practice fits the statutory IDR mechanism the firm is built around.

The One-Claim Test

Working with attorney Eliott Dear does not start with a contract. It starts with a single EOB. You send one explanation of benefits from a non-par claim where the carrier underpaid. Eliott Dear runs the eligibility check, classifies the plan as fully insured or self-funded ERISA, runs the FAIR Health benchmark for the CPT and ZIP, and tells you whether the claim should go to state IDR, federal IDR, or neither. No upfront fee. No retainer. No long-term contract. The full structure of the engagement is laid out at Eliott Dear on the Claims Assassins 10% Contingency.

What the Attorney Does

Once a claim is intake-approved, Eliott Dear personally builds the IDR submission. That means reading the operative note, reviewing the EOB and the carrier’s payment rationale, pulling the FAIR Health benchmark for the CPT and ZIP, drafting the legal argument, and signing the filing. Carriers staff their IDR responses with attorneys and actuaries; the provider side has to match that, or the arbitrator hears one fully-argued position and one form letter. The structural reasoning is in Eliott Dear on Attorney-Signed IDR.

On every Eliott Dear attorney filing, the signature on the petition is the attorney’s. The arguments inside are the attorney’s. If the carrier challenges the QPA, the response is built by counsel. If the IDRE asks for additional briefing, the response goes back from counsel. The practice never fields a procedural question from the IDR portal because every procedural question routes through the attorney.

What the Practice Does

The practice’s side of the engagement is light by design. Send EOBs, send operative notes, answer the occasional clarifying question. The full claims pipeline, from the submission of charges through the IDR portal to the receipt of the award, is operated by Claims Assassins. The practice never logs into the DFS portal, never argues with an IDRE, never tracks a determination deadline. That is the entire point of bringing in counsel: the procedural and legal labor moves off the practice.

The Recovery

On state IDR, the determination lands within roughly 30 days of submission, and the carrier pays within 30 days of the determination. The award is paid directly to the practice. Claims Assassins invoices for 10% of the improvement over the original carrier payment. There is no improvement, there is no fee. The alignment is structural: the firm gets paid only when the physician collects more than the carrier originally allowed.

The reimbursement profile across the Claims Assassins docket is consistent. Most state IDR awards land at or near the FAIR Health 80th percentile, which is typically a multiple of the original carrier allowance. The exact number depends on the CPT, the place of service, and the ZIP-coded benchmark. The structural reason the FAIR Health benchmark wins is in Eliott Dear on the FAIR Health 80th Percentile.

What to Expect After the First Win

After the first Eliott Dear attorney filing closes, most practices send their full non-par EOB feed to Claims Assassins on a recurring basis. The intake sort separates fully-insured (state IDR track) from self-funded ERISA (federal IDR track) automatically, and the firm files what fits. The cadence becomes operational rather than episodic. New EOBs come in, new IDRs go out, awards come back. The legal posture stays the same on every filing: attorney-signed, FAIR Health benchmarked, built to win on the merits.