Patient Frequently Asked Questions:
What is a Surgical Assistant?
A Surgical Assistant is a surgically skilled medical professional specifically trained to assist in surgeon procedures to help ensure the safety and the best possible outcome for the patient. Assistants offer hands-on assistance to the surgeon during the procedure, such as suturing, graft preparation, retraction, etc. Having those extra set of expert hands in the operating room means that you are getting top-notch medical care while reducing the time you are under anesthesia.
Who determines if an Assistant at Surgery is utilized?
Once your surgical procedure and medical history were reviewed, your surgeon determined that an Assistant was medically necessary for your safety and well-being. The American College of Surgeons (ACS) has determined that assistant surgeon services are required for the successful completion of certain surgical procedures that have been identified as sufficiently complex or intensive.
Why am I getting a bill?
Assistants at Surgery are not employees of your surgeon and are considered ‘providers’ by the healthcare industry. Therefore, the Assistant bills your insurance company for their services separately from your surgeon. Once the claim is processed and we have thoroughly exhausted our resources to acquire payment from the insurance company, you may receive a statement for any balance that your insurance company may determine you are responsible for.
Why didn’t my surgeon tell me he was going to use an Assistant?
For your safety and optimal procedure outcome, your surgeon may decide there is need for certain services or providers to be involved in your care, as with many other technical issues which they may or may not have discussed with you prior to your surgery. Some surgeons do not wish to burden their patients with excessive information that they feel would not be vitally important for their patient’s impending surgery and recovery. Your surgeon also made many similar pre-operative decisions, such as choices of anesthesia, type of instruments,
medical supplies or surgical implants to use, etc., which he or she may or may not have discussed with you prior to your surgery.
medical supplies or surgical implants to use, etc., which he or she may or may not have discussed with you prior to your surgery.
Why do I have to pay for the Surgical Assistant’s services when I did not authorize it? Since my surgeon asked the Assistant to provide services, shouldn’t my surgeon pay for it?
The need for an Assistant at Surgery cannot always be predicted. When you selected your surgeon, you relied upon his or her good judgment and skill to make decisions that were in the best interests of your health and well-being. There are many decisions that your surgeon made on your behalf in the process leading up to your surgery. After thoroughly reviewing your medical history and the surgical procedure that was to be performed, your surgeon determined that it was more sensible, safer and would provide the best possible outcome for your surgery to have a Surgical Assistant present during your surgery. The hospital policy regarding services and costs are stated on the surgical consent form.
Why is my insurance company not covering the services of a Surgical Assistant?
Because it is based on the policy purchased by the member and not the true needs of the surgeons. Most assistants are not able to participate in every PPO and HMO because insurance companies do not cover this necessary service. Most insurance companies will cover the charges if the patient appeals directly to them and request payment(s) be made. You have significant influence over your policy and may be able to get the determination of benefits changed.
