Some surgical assistants are using arbitration provisions in federal billing law to collect far more than the surgeons they assist, according to The New York Times.
Surgical assistants are typically paid a standard fee equal to about 16% of a surgeon’s reimbursement. But some are now collecting far more than the surgeons they assist by capitalizing on a law meant to protect patients from surprise billing, according to a New York Times report.
Five things to know:
1. Some surgical assistants are earning up to 25 times what the operating surgeon makes, The New York Times found, based on payment data and interviews with health plan officials.
2. The assistants are taking advantage of the No Surprises Act, which allows out-of-network providers to pursue arbitration and argue for payments well above what insurers would otherwise offer.
3. In one example cited in the report, a surgical assistant in Dallas won $50,456 through arbitration in March for a prostate removal procedure. The surgeon who performed the operation and accepted the patient’s insurance was paid $1,843.
4. Brady Connaughton, a New Jersey lawyer who advises union health plans, said it “is crazy” for assistants to regularly out-earn the lead surgeon, calling the pattern a disregard for the law’s intent.
5. Thomas Nyhan, executive director of TeamCare, a health plan covering about half a million union workers, said his plan has spent $19 million on arbitration cases since 2022. He warned that as out-of-network arbitration becomes more lucrative, providers may have less incentive to join insurance networks at all. Surgical assistant groups counter that health plans often exclude them from networks altogether, leaving reimbursement unpredictable and low.
Read the full report at The New York Times.
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