08/05/2026
The Payer Said No Twice. Here's What I Tell Providers to Do Next.
When a provider calls me frustrated — they appealed, the payer recycled the same denial language, and now they're wondering if it's even worth fighting — my answer is always the same.
You've been playing on the payer's field. Let's change the field.
Most out-of-network providers default to 2 paths when a claim gets underpaid: appeal it, or negotiate informally and hope the payer budges. Both have their place. But here's the problem — both keep the payer in control of the outcome.
Appeals? The same organization that underpaid you decides how seriously to review your dispute. Informal settlements? They depend on leverage that shifts case to case, contact to contact, mood to mood. I've seen providers accept partial compromises just to close a file — and leave thousands of dollars on the table because the file had been sitting too long and someone blinked.
Arbitration is different. Not because it's magic — because it's structured.
Once a claim enters the federal Independent Dispute Resolution process, the payer no longer controls the timeline, the review, or the decision. An independent arbitrator looks at the evidence. They pick 1 offer — not a split, not a compromise. One. And because the process rewards strong documentation over payer delay tactics, providers who come in prepared win. A lot.
At Callagy Recovery, our win rate is 92% across all carriers, all 50 states, all specialties. We target recovery at 75-85% of billed charges. And we front every filing fee — so providers pay nothing out of pocket to start.
The question I get most often is: how do I know which claims belong in arbitration?
Honestly? You don't have to figure that out. We do. Callagy Recovery reviews your claims, identifies what's eligible, and handles every step of the process. You hand us the files. We fight. You get paid.
The providers I work with who build arbitration into their recovery strategy — not as a one-off, but as a repeatable process — are the ones who stop being surprised by their cash flow and start predicting it.
That's what a reliable recovery path actually looks like.
If you're managing out-of-network claims and wondering whether your current approach is leaving money behind — I'd love to have that conversation. Call or text me at 732-456-4476.
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