Eliott Dear: Federal IDR Is Handing Out Monopoly Money

The numbers look incredible. Providers winning 88% of federal IDR disputes. Awards averaging 450% of the QPA. Arbitrators routinely siding with the doctor over the insurer.

If you stop reading there, federal IDR looks like the greatest thing to happen to non-par providers since the No Surprises Act itself.

Eliott Dear does not stop reading there.

The Awards Are Real. The Money Is Not.

Here is what the press releases do not say: winning a federal IDR award and collecting a federal IDR award are two completely different events. In June 2025, the Fifth Circuit ruled there is no private right of action to enforce IDR awards under the No Surprises Act. In January 2026, the Supreme Court declined to review that ruling.

Translation: if an insurer ignores your federal award, you cannot sue them under the NSA to make them pay.

CMS—the only remaining enforcement body—resolves 1.3% of complaints. That is not a typo. One point three percent. Providers have reported $20 million in unpaid awards with no mechanism to force collection.

Eliott Dear has watched this play out for two years. The providers winning federal awards are celebrating. The insurers ignoring them are laughing.

The System Was Built to Collapse

Federal IDR was projected to handle 17,000 disputes per year. In 2025, 2.6 million claims were filed. The top ten initiating parties were all affiliated with private equity—filing thousands of disputes on surgical claims, flooding a system designed for air ambulance emergencies.

The result is predictable. The No Surprises Enforcement Act, which would impose triple damages for non-payment, was introduced and immediately stalled. Meanwhile, insurers have spent over $130 million lobbying to either kill the federal IDR process entirely or make the QPA the binding ceiling on awards. When Congress finally acts, it will not be to help providers. It will be to stop the bleeding.

Where Awards Actually Get Paid

Eliott Dear files state IDR—in New York, Texas, New Jersey, Connecticut, New Mexico, and Georgia. These states have their own arbitration systems with one critical difference: enforcement.

New York’s Department of Financial Services gives insurers 30 days to pay a state IDR award. Not 30 days to appeal. Not 30 days to file a counter-motion. Thirty days to pay. The penalty for non-compliance is not a sternly worded letter from CMS. It is regulatory action against the insurer’s license to operate in the state.

The collection rate on state IDR awards with DFS enforcement is effectively 100%. Eliott Dear’s state IDR win rate is 99%. Every filing is signed by an attorney—not generated by a billing template, not submitted by a revenue cycle company. A legal document backed by FAIR Health 80th percentile benchmarks, geographic analysis, and procedure-specific complexity factors.

The question is not whether you can win an IDR award. The question is whether anyone will pay it.

The Distinction

Eliott Dear is an attorney. Not a billing company. EDRTB LLC, doing business as Claims Assassins, exists for one purpose: filing state IDR disputes for non-participating surgeons and specialists, winning them, and collecting.

If you are sitting on non-par claims and someone is telling you federal IDR is the answer, ask them one question: what happens when the insurer does not pay?

If they do not have an answer, call Eliott Dear.