Why can't you bill Medicare for my procedure?

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Currently services of a Surgical First Assistant are not included in Medicare coverage.  Surgical first assistants are a relatively new type of provider, having come into prominence with the rise of laparoscopic and robotic surgery.  As a newer group, Medicare has not as yet established the guidelines for recognition of surgical assistants and will not reimburse these providers until it does. We at Metropolitan Surgical Assistants are working with the Association of Surgical Assistants at the state and federal levels to facilitate this process.  At this time, however, we must turn to our patients for payment.  Some Medicare replacement plans and secondary plans will pay, so please feel free to ask us about your situation.

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Why are you out of network for my insurance?

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At this time, insurance carriers will not contract with surgical first assistants.  The reason for this is related to the Medicare issue above and is not by our choice.  We understand that an out-of-network provider may result in unanticipated costs to you and we make every attempt to get your insurance carrier to pay, through either appeals or negotiated rates when available.  The contract that you signed with your insurance carrier may also limit what they will pay, and we are unable to do more than what your insurance will permit.

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Why does my surgeon need your services?

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Your surgeon has requested the presence of a surgical first assistant for your best outcome.  Robotic and laparoscopic cases cannot be done without an assistant, whose role, among other things, involves monitoring the laparoscope or robot.  Some open cases may be done without an assistant, but your surgeon has requested a second set of hands to ensure he has the best visibility and access to the areas in which he is working.  In using an assistant, your surgeon makes his decision relying more on his best medical opinion and judgment for a good outcome and less on any additional cost involved. If cost is an issue to you, please feel free to discuss this with your surgeon, we are happy to work out any payment plan that you can be comfortable with.

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Are Surgical First Assistants Licensed?

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Since 2000 several surgical first assistant groups have attempted to receive licensure in Arizona.  At each attempt, the legislature has determined licensure is not necessary and each hospital will be responsible for verifying the education and certification of the surgical first assistants it allows to practice there.  While we continue to work for licensure in Arizona, we feel it is very important for the lawmakers to hear from their constituents, and we encourage all our patients to write or call their representatives.  Please contact us if you would like help in this matter.

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