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 through the determination and the payment demand that follows it. 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, confirms whether the plan is fully insured, runs the FAIR Health benchmark for the CPT and ZIP, and tells you whether the claim belongs in state IDR. 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 contests the benchmark, 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 determination and the payment demand, 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 Determination and the Fee

On New York state IDR, a determination carries a 30-day payment deadline, and Claims Assassins sends the payment demand. Any payment on the determination goes directly to the practice. Claims Assassins invoices for 10% of the improvement over the original carrier payment. If there is no improvement, there is no fee. The alignment is structural: the firm earns a fee only on an improvement over what the carrier originally allowed.

Every Claims Assassins submission is built on the FAIR Health 80th percentile for the CPT, the place of service, and the ZIP-coded benchmark, and the original carrier allowance is measured against it. Why that benchmark carries the weight it does is in Eliott Dear on the FAIR Health 80th Percentile.

What to Expect After the First Filing

After the first Eliott Dear attorney filing, a practice can send its full non-par EOB feed to Claims Assassins on a recurring basis. The intake sort pulls out the fully insured plans that belong on the state IDR track, and the firm files what fits. The cadence becomes operational rather than episodic. New EOBs come in, new IDRs go out, determinations come back. The legal posture stays the same on every filing: attorney-signed, FAIR Health benchmarked, argued on the merits.