IDR for surgeons: file and win No Surprises Act arbitration

Flat fee per arbitration. Your group keeps every dollar of the award.

Surgical claims are the biggest book in federal arbitration, and payers count on surgeons never filing. The No Surprises Act gave out-of-network providers a federal process called independent dispute resolution (IDR), and the published record shows surgical specialties win it more than 85 percent of the time. IDR for Surgeons runs that process for your group: eligibility, deadlines, evidence, and filing.

All 3.39 million federal IDR disputes published by CMS, 2023 through 2025. Explore the data at idrexplorer.com.

What surgeons win at federal IDR

Every federal IDR decision is public. Here is the record by surgical specialty, from all disputes CMS published from 2023 through 2025.

Computed at the dispute level from the CMS federal IDR public use files, 2023 through 2025. Median award is the median published award on disputes the provider won.

Two things stand out in that table. First, the win rates are not close: arbiters side with surgeons in roughly 9 of 10 plastic surgery and assistant-at-surgery disputes. Second, the groups filing these disputes are overwhelmingly small private practices, not hospital systems. The process was built to be usable by a three-surgeon group, and the record shows three-surgeon groups using it.

Which surgical claims qualify

The No Surprises Act opens two doors for a surgeon's out-of-network claims:

• Emergency care. Surgery that begins in the emergency department, including on-call trauma coverage, facial trauma call, and emergent general surgery. Patients cannot waive these protections.
• Out-of-network surgery at an in-network facility. Cases you perform at a hospital or ambulatory surgery center that is in the patient's network while you are not. For scheduled cases, payers sometimes argue the patient signed a notice and consent waiver, but assistant surgeons can never be waived, and valid waivers are rarer than payers claim.

Procedures performed in your own office do not qualify, and claims under Medicare, Medicaid, or self-pay patients are outside the process. The details, including how state arbitration laws interact with the federal process, are in our eligibility guide.

Why surgical groups come to us

Deadlines are short and easy to miss

Every No Surprises Act deadline is counted in business days: 30 to start negotiation after the payer's payment, 30 to negotiate, 4 to file for arbitration. Miss one and the claim is gone. Most groups track all of this in a spreadsheet next to the OR schedule. We track every deadline on every claim.

Paid is not the same as paid fairly

An underpaid surgical claim never shows up in a denial queue, because the payer technically paid it. A spinal fusion or a flap reconstruction comes back at a small fraction of what the case is worth, the explanation of benefits says processed, and the revenue is simply gone. Arbitration changes that math: across all published disputes, the median federal IDR award runs 4.7 times the qualifying payment amount the payer started from.

Assistant and co-surgeon claims slip through

Claims billed with assistant surgeon or co-surgeon modifiers are usually too small to fight one at a time, so they get written off. In arbitration they perform as well as anything in the surgical book: 17,926 published disputes, an 89.8 percent provider win rate, and a median award of $12,203 when the provider won. Filed in batches, they stop being rounding errors.

Most filers take 15 to 25 percent of the recovery

IDR vendors and law firms usually charge a percentage of what they win for you, the dollars recovered above the payer's initial payment. On a $50,000 recovery, 15 to 25 percent is $7,500 to $12,500. The work is the same either way, so we price it the same either way: a flat fee per arbitration, and the award is entirely yours.

How it works

1. We find the eligible claims. From your remits, we flag which out-of-network surgical claims qualify under the No Surprises Act and what similar cases have won in your state and specialty.
2. We prepare and file everything on time. Open negotiation notices, IDR initiation, offers, evidence packets, each inside its deadline. You approve every offer and see the status of every dispute.
3. You keep the award. Payers pay your group directly. Our flat fee per arbitration is the same whether the award is $500 or $50,000, so our incentive is simple: file everything worth filing, and win it.

Built on all 3.39 million federal IDR decisions

IDR for Surgeons is run by Lido IDR, which published the entire federal IDR record at idrexplorer.com: every dispute, every payer, every IDR entity, and award benchmarks for more than 800 specialty and state combinations. That data powers our filings, from picking winnable claims to setting offer amounts.