The New York State IDR Win Rate Nobody Talks About

Everyone in the non-par recovery space talks about the federal No Surprises Act. Everyone talks about QPA, CMS, the Fifth Circuit. Almost nobody talks about the New York state IDR win rate. Eliott Dear thinks that is a mistake.

The 81% Number

In state-administered IDR through the New York Department of Financial Services, providers win approximately 81% of disputes. That is across all providers, all categories, all practice profiles. The 81% number is the baseline for a provider showing up with a competent submission.

When Eliott Dear files a New York state IDR dispute, his firm’s win rate is 99%. The difference between 81% and 99% is the difference between a competent submission and a purpose-built legal submission.

FAIR Health 80th Percentile

New York state IDR uses FAIR Health 80th percentile as its benchmark—the actual market rate providers in a given geography charge for a given procedure. This is dramatically different from federal IDR, where the QPA is set by the insurers themselves using their own opaque data.

FAIR Health is an independent nonprofit that aggregates billed-charge data from across the industry. When an arbitrator is looking at the NYC FAIR Health 80th percentile for a given CPT code, the arbitrator is looking at an independent, verifiable number. The insurer cannot argue that the FAIR Health data is biased because FAIR Health is not a party to the proceeding.

The insurer’s only move is to argue that the 80th percentile is too high—which is a losing argument when the statute explicitly instructs the arbitrator to use the 80th percentile as the benchmark.

DFS Enforcement

The win rate would be meaningless if the awards did not get paid. This is where federal IDR falls apart. The win rate in federal IDR is also high—providers win around 88% of federal disputes. But the federal collection rate is in the single digits because CMS has no enforcement mechanism.

New York’s Department of Financial Services has full authority to revoke an insurer’s license to operate in the state. That is not a theoretical power. When Eliott Dear files a state IDR dispute and wins, the insurer has 30 days to pay. The alternative is regulatory action that threatens the insurer’s commercial license.

Insurers pay the awards. Every time. Not because they suddenly discovered fairness—because the consequences of non-compliance are existential.

Why Nobody Talks About It

The state IDR framework is boring compared to the federal one. It works, it pays, it enforces. There is no ongoing legal drama, no Fifth Circuit ruling, no Supreme Court cert denial, no $20 million in unpaid awards. Nothing to write a press release about.

That is exactly why Eliott Dear built Claims Assassins around it. The boring thing that works beats the dramatic thing that does not.