FREQUENTLY ASKED QUESTIONS
1.) what's an Assistant Surgeon?
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Clamping and cauterizing tissue and blood vessels to minimize blood loss
Re-checking your records to be sure all necessary precautions have been taken.
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Retracting
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Identifying and protecting vital structures and organs
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Irrigating
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Suctioning
Coordinating with a multidisciplinary team of professionals to ensure the appropriate equipment, instrumentation, medications, and implants are available based on your Physicians preferences.
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Suturing
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Stabilizing fractures and fragile tissue
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Monitoring the continued sterility of the operative field
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Often times, the primary Surgeon delegates the closure of surgical incisions to the Assistant.
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If drains are to be left in place they will be secured at this time.
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In addition, the assistant will apply any needed wound vacs, dressings, splints, casts, braces, or binders.
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Before leaving the operating room, the assistant will reassess your condition to ensure you are stable for transport.
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Some licensed assistants may write post operative orders, make rounds to visit with you the days following your procedure, and even discharge you on behalf of your primary Surgeon.
2.) why do i have to pay?
Great question! We would actually like to know that answer to that as well. Unfortunately insurance companies, along with federal and state legislative bodes have set reimbursement rates for most assistant surgeons far below the market standard prior to instituting The No Suprise Billing Act that was passed within the Covid relief package back in December of 2020.
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The intent of this legislation was to protect patients from outrageous healthcare bills by providers who were out of network. This is a very noble gesture on the surface, however the truth is far more complex than what we were told in marketing campaigns.
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In the past, if patients received a "balance bill" for services rendered, it would be the difference between the providers billed charges, and insurance coverage payment. What happened is insurance companies began denying payment for covered services and assigning the balance to "patient's responsibility." This lead to patients receiving bills they were not expecting from healthcare providers they never knew were out of network.
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Many people are unaware that providers have to apply to become in network. Not all providers are able to do that for sundry of reasons including insurance company rules, and unrealistic fee schedules. In addition, there are thousands of different insurance plans and carriers with constantly changing coverage plans. It is not possible to join them all, or keep track of all the changes.
The other important thing to note is that many providers work independent of hospital systems. Meaning they are not employed by a hospital they may have "privileges" to work in.
This is why you may be in a network facility but be treated by an out of network provider.
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As a Registered Nurse First Assistant, most insurance carriers will not allow us to be in network as a provider. They have what is called a "closed panel." This requires us to work as out of network providers. If an insurance carrier is willing to offer us network status, the reimbursement rates are far below the wages necessary to stay in business. For this reason we bill separately for our services.
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In the past we were able to make appeals for several months and some plans would ultimately pay for services rendered according to their plans covered benefits. However most would not. When the federal government passed the "No surprise billing act" this allowed the insurers to determine reimbursement rates. Currently they use Medicare rates to determine reimbursement for services rendered. Those rates are far below market value.
In an effort to continue providing these much needed services, most assistants have gone to a cash pay system. Patients pay upfront and can then submit their claim to their insurance company for reimbursement.
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Many of my colleagues have left the profession, changed specialities, retired, or have gone out of business. It is unfortunate for patients, providers, and all of the families that have been adversely affected by the power of big business using their money and influence to determine the laws that govern our land.
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3.) Can I get reimbursed?
Probably.
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It will take some effort on your part, but you can submit this claim to your insurance company and request reimbursement for payments made. You can also use flexible spending accounts, or health savings money to pay for the assistant surgeon fee.
Our billing company will be in touch with you to go over payments, reimbursement, and your options. Ryan is very well versed in insurance industry claims and can guide you through the process of submitting forms to seek repayment.
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4.) Can i use my flexible spending or hsa account?
Yes.
5.) Can my surgeon find someone else to help who is in network?
Possibly. You can certainly ask your surgeon if there is someone else available to assist that is in your network.
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Here are some of the confounding issues that arise when attempting to coordinate all necessary providers for an upcoming surgical procedure:
Minimum Team members that must be available:
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Facility operating room
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Surgeon
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Anesthesia
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Assistant Surgeon
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Nurse
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Surgical Scrub Tech
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Device company reps (as needed)
Minimum requirements for each team member:
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Provider training
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Provider availability
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Provider credentialing
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Provider network status
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Surgeon preference
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Coordinating a surgery is tedious and if it is not possible to align all of the providers, surgery dates have to be postponed.
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It is certainly an option worth exploring if having an in network provider is important for you. Just let your surgery scheduler know this is a route you'd like to take so they can make the necessary adjustments to your upcoming procedure.
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