IDR Pros Serviced by Smith Law
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Out-of-network reimbursement · Florida

IDR is just the beginning.

Florida law recovers what IDR cannot.

IDR Pros, serviced by Dan Smith, Esq. of Smith Law, represents Florida physicians, physician groups, and hospital-based departments against Blue Cross, United, Cigna, Aetna, and other carriers. Every underpaid claim is pursued through federal IDR, Florida state court, or both.

Request a complimentary claims review Call (813) 523-3134

Contingency fee. No hourly billing, no retainer, no upfront cost.

The No Surprises Act

The system is working, for providers who know how to use it.

The No Surprises Act gave providers a federal arbitration process to challenge insurer underpayment. Nationally, the numbers favor providers.

88%of IDR determinations nationally go to the provider
2.7–4.5×average award, measured against the insurer-calculated median in-network rate
300,000disputes filed per month
17×the volume regulators originally projected

Our results are stronger. Our IDR win rate exceeds 90%. We have recovered multiples of Medicare rates for specialties from hospitalist groups to trauma surgeons. And when we use litigation outcomes to negotiate in-network agreements, we have secured rates three times previous payment levels.

But IDR is only half the story. The real story is Florida.

Two prongs

Every claim gets pursued.

Our software connects to the billing system you already use and sorts every underpaid claim into the forum where it recovers the most.

Prong 1

Federal IDR for eligible claims

Our proprietary software integrates directly with your current billing system to identify which claims are IDR-eligible. Our team prepares submissions calibrated to win.

  • Eligibility identified automatically from your billing data
  • Submissions prepared by our team
  • Unpaid awards enforced through Florida civil litigation, not CMS complaints
Prong 2

Florida litigation for everything else

The same software identifies which claims are eligible for Florida state court action and appeal.

  • The 17–20% of disputes found ineligible for IDR nationally, recovered through direct lawsuits under Florida's statutory framework
  • Underpaid out-of-network claims that were never IDR-eligible, recovered too
4 years

No claim falls through the cracks. We can go back four years on old out-of-network claims, so revenue you may have written off is still recoverable.

Florida law

Why Blue Cross, United, Cigna, and Aetna settle.

Long before Congress passed the No Surprises Act, Florida enacted statutes creating independent, enforceable rights for nonparticipating providers. In January 2022, CMS formally recognized those laws as "specified state laws" that control over the federal default.

Florida's reimbursement standard favors providers.

Under Fla. Stat. § 627.64194 and § 641.513(5), insurers must reimburse nonparticipating providers at the lesser of the provider's charges, the usual and customary charges for similar services in the community, or a mutually agreed amount. Florida law requires the very factors that support higher reimbursement.

Providers can sue directly in state court.

Section 627.64194(6) gives providers a choice: resolve disputes through voluntary state arbitration, or go directly to a court of competent jurisdiction. Full discovery. Jury trials. Judicial review. Tools that no arbitration process provides.

Federal IDR compared with Florida law
 Federal IDRFlorida law
Payment anchorInsurer-calculated QPAUsual and customary charges in the community
Billed chargesConsideration prohibitedPart of the statutory standard
ForumArbitrationArbitration or state court, provider's choice
DiscoveryNoneFull discovery
Jury trialNoYes
ReviewVery limitedJudicial review and appeal

We have litigated hundreds of lawsuits across thousands of claims against major carriers in Florida, all resolved by settlement or plaintiff judgment.Insurers settle because a 90%+ IDR win rate, provider-favorable state reimbursement standards, direct court access, and a firm that will litigate to conclusion make settlement the rational choice.

Blue CrossUnitedCignaAetnaOther major carriers
ERISA preemption

For many providers, ERISA is where claims go to die. Not here.

Insurers have used ERISA preemption as a shield for decades. We have obtained hundreds of provider-friendly court orders defeating the ERISA preemption defense raised by insurance giants, at both the federal and state level, in an unbroken chain dating back to 2017.

If you've been told ERISA means you can't recover, you were told wrong.
100sof provider-friendly court orders defeating ERISA preemption
0losses on the ERISA preemption defense
2017unbroken chain of orders, federal and state

Past results do not guarantee future outcomes. Each case is evaluated on its own merits.

Who we represent

If you provide out-of-network care in Florida, we recover the full reimbursement the law provides.

Solo practitioners, physician groups, and hospital-based departments.

Specialties

Emergency medicine Anesthesiology Surgery Hospitalists Radiology Groups treating ER-admitted patients

Contingency: you pay nothing unless we recover.

$0Hourly billing
$0Retainer
$0Upfront cost

We get paid when you get paid.