When a healthcare provider wins a federal Independent Dispute Resolution (IDR) award, it might seem like the battle for reimbursement is over. But a recent case involving a multi-location cosmetic surgery and dermatology group shows that winning an IDR determination does not necessarily mean the reimbursement process is complete. CollectionPro Services LLC, a specialist in out-of-network reimbursement and IDR, is highlighting the case, which demonstrates a growing concern for out-of-network providers: even after a favorable IDR decision, payment may remain unresolved, requiring further legal action.
The dispute involved CPT 19318 and UnitedHealthcare. UnitedHealthcare submitted an offer of $0, while the provider submitted an offer of $72,000. On February 18, 2026, the designated IDR entity selected the provider's full $72,000 offer and declared the provider the prevailing party. The IDR determination required any amount due following the decision to be paid within the applicable 30-calendar-day period. However, the award remained unpaid for months despite repeated reminders and demands for payment.
With CollectionPro's strategic guidance and active support, the matter proceeded to the New York State Supreme Court, New York County, under CPLR Article 75. The petition sought enforcement and payment of the $72,000 IDR award, along with statutory interest, the IDR entity fee, associated costs and disbursements, and any other appropriate relief. This case illustrates the distinction between receiving a favorable IDR determination and ultimately pursuing the payment associated with that determination.
"Providers should not have to assume that their work is finished simply because they received a favorable IDR determination," said David Nissanoff, spokesperson for CollectionPro. "The real objective is not just to win arbitration. It is to pursue the reimbursement the provider has been awarded. When payment remains unresolved after a favorable determination, providers need to understand what options may be available for the next stage of recovery."
CollectionPro's approach to out-of-network reimbursement extends across the recovery lifecycle rather than focusing solely on arbitration filings. Its process can include open negotiation, IDR strategy, evidence development, IDR determination, award tracking, and post-award escalation and enforcement support. This end-to-end approach is particularly relevant as providers navigate an increasingly specialized reimbursement environment under the No Surprises Act.
The company focuses specifically on out-of-network revenue recovery, including payer negotiations, appeals, IDR support, aged accounts receivable as well as post-award collections. CollectionPro reports more than 10,000 out-of-network arbitrations filed and a 92% success rate, while its model includes advancing applicable arbitration costs and charging providers only following successful recovery.
For CollectionPro, the distinction is central to how the company approaches IDR. Rather than viewing a favorable determination as the automatic end of a case, CollectionPro maintains visibility into what happens after an award and supports providers as reimbursement progresses through subsequent stages. Winning in IDR arbitration is one thing; actually collecting the award is another and where experienced expertise is needed. CollectionPro thus helps providers maintain momentum throughout that process instead of treating the arbitration decision as the finish line.
