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When Izzy Benasso tore her meniscus during a friendly game of tennis with her father, she had to undergo a repair operation to fix the damage. Thankfully, the operation went well. However, she received an unwelcome surprise when the Benassos learned that a surgical assistant was present during Izzy’s operation. That put them on the hook for an extra $1,000 on her medical bill.
The total bill from Sky Ridge Medical Center in Colorado, where Izzy had her option, was $96,377. The hospital accepted $3,216.60 from the Benasso’s insurance company along with $357.40 from the Benassos themselves as payment in full. What wasn’t covered was a separate charge from the surgical assistant for $1,167.
Soon after her operation, Izzy received a notice from an unknown person, Eric Griffith, a Denver-based surgical assistant.
“I’m writing this letter as a courtesy to remind you of my presence during your surgery,” said the letter obtained by Kaiser Health News.
The Benassos experienced first-hand a growing trend in health care: third-party surgical assistants who aren’t part of a hospital staff or a surgeon’s practice. Steve Benasso had given careful instructions to his daughter about what to ask the clinic regarding her insurance coverage. Unfortunately, he didn’t know enough to tell his daughter to ask whether surgical assistants would be present during her operation. And, if so, would they be by her health insurance.
“We were pretty conscious going into it,” he told KHN.
Surgeons generally decide when they need surgical assistants, although the federal Centers for Medicare & Medicaid Services maintains lists of procedures for which a surgical assistant can and cannot bill. Meniscus repair is on the list of allowed procedures.
According to Karen Ludwig, executive director of the Association of Surgical Assistants, about 75 percent of certified surgical assistants are employed by hospitals, while the rest are independent contractors or employed by surgical assistant groups.
This emerging area of business can be lucrative.
Some of the larger surgical assistant companies are backed by private equity firms that often target segments of the health care system where patients have little choice in who provides their care. The article points out that, under anesthesia for surgery, patients are often unaware the assistants are in the operating room. The private equity business models include keeping such helpers out-of-network so they can bill patients for larger amounts than they could negotiate from insurance companies.
The Benassos were able to find a resolution for the outstanding bill with their insurance provider, but as hospitals across the country restart elective surgeries, patients should be aware of this emerging trend.
If you’ve received a bill from a surgical assistant? Share your story with Voices for Affordable Health.