"Bob" didn't plan on getting hit by a car during his New York City getaway, but the man in a matte black Porsche Cayenne checked his Instagram feed, ran the red light, and sent him flying across the crosswalk.
He was rushed to Mount Sinai Hospital, and if it weren't for Dr. Gotham who was on call at 2 a.m., he might have died.
The Provider Behind the Care
Luckily "Dr. Gotham" wasn't just any physician on call that night. He was a board-certified orthopedic surgeon, fellowship-trained in complex fracture care, and a published author. He had spent two decades repairing broken bones and teaching residents how to keep calm in the chaos of a Level I trauma bay.
The Shocking Payment
And yet, for saving Bob's life after a head-on collision with a mid-sized SUV, Dr. Gotham received a shocking payment: $410.98. For the 10 hours it took to stabilize him, the team he marshaled, and the sleepless night, Dr. Gotham was paid $410.98. A sum that barely covered the suture kit, let alone his time, expertise, and liability.
Why So Low?
Dr. Gotham was out-of-network with the patient's insurance plan. In situations in which a provider has no contracted rate, insurance has all the power and incentives to underpay providers.
Since the No Surprises Act made it illegal to balance bill patients for emergency cases, Dr. Gotham was left stranded in a tug-of-war with a multibillion-dollar insurer to recoup the outstanding $25,000 bill.
The Typical Outcome
In most of the stories we hear, this is the part where the provider gives up and never does an out-of-network surgery again. It's much easier to fall in line and only see in-network patients where the reimbursements are predictable. We want to change that narrative.
The Solution: Independent Dispute Resolution
If this story sounds familiar, whether you're a practice manager, healthcare administrator, or a provider yourself, the Independent Dispute Resolution (IDR) process may be what your billing strategy is missing. We wish that more providers knew about how useful IDR is.
The IDR process is a federally mandated arbitration system designed to settle out-of-network billing disputes. Since its launch in 2022, providers have prevailed in the majority of cases, with win rates often exceeding 75–80% and arbiters often award payments that are multiples above the in-network rates.
"If doctors work like heroes, we believe they should be paid like heroes."
Ready to Recover What You're Owed?
If cases like Dr. Gotham's sound familiar to your practice, it's time to explore the IDR process. Contact us today for a free review of your out-of-network claims and see how much revenue you might be leaving on the table.
Next steps
Turn the analysis into a recovery path.
Open negotiation, evidence development, filing support, arbitration, and payer follow-up.
IDR eligibility guidelinesScreen plan type, service category, facility context, timing, and federal versus state routing.
Rate transparency analysisUse payer data and market benchmarks to support reimbursement strategy.
Send a claim sampleAsk MedRes to review an underpaid claim and identify the right recovery route.
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