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Can You Be Billed for an Out-Of-Network Assistant Surgeon?

Surgical assistants are in the operating room to aid the surgeon during the procedure. Many of them own their own businesses and are contracted to the hospitals, making them out-of-network for most insurance carriers. Like the anesthesiologist's bill, the one for the surgical assistant may arrive as a separate bill from that issued by the hospital or surgeon.

  1. Reimbursement

    • Insurance companies usually handle out-of-network charges after you have paid the bill. You submit the bill and receipt for reimbursement. The company will review the documents submitted and will then send you a check for the services that are covered under your policy.

    Coverage

    • Although all insurance companies have their own specific treatments for out-of-network surgical assistant reimbursements, they all generally follow a similar procedure. One surgical assistant is covered. The amount of coverage depends on the total price of the surgery. The allowance for a surgical assistant is up to 20 percent of the surgery bill (the bill total multiplied by up to 20 percent). This is the maximum amount of any reimbursement you will receive.

    Second Assistant

    • Doctors often hire two assistants for complex surgeries. To decide on payment for the second assistant, the insurance company evaluates the procedure's complexity and necessity. If the company decides that your surgery warranted a second surgical assistant, you can be reimbursed. The company will inform you of the limits for this special reimbursement.

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