Every major operation requires the services of an Assistant Surgeon. He or she is that anonymous doctor ready to step in and take over surgery in case the Surgeon becomes incapacitated during the medical operation. When it comes time to submit his or her bill for medical care, the assistant surgeon often faces objections from both the insurance company and the patient.
When a patient is scheduled for an operation, the surgeon’s office will make the necessary arrangements with the patient’s insurance plan to approve the medical services. Since the surgeon, then will almost always select the physician who will be the assistant surgeon, an anomaly can arise where the surgeon is within network but the assistant surgeon is not.
Insurance companies will often take the position that since the assistant surgeon was not within the plan, the bill for medical services should not be paid or should be paid at out of network rates.
When representing the assistant surgeon, I have advised, the insurance carrier that 13:35-4.1 of the – New Jersey Administrative Code requires the services of an assistant surgeon; and that once the operation was approved at in net work rates for the Surgeon, the assistant surgeon is also covered. I have successfully sued insurance companies on that basis for the Assistant Surgeons.
Sometimes it is the patient who objects to payment claiming “I never hired the Assistant Surgeon. I don’t know who he/ or she is and I never heard of him/ or her.” In a recent case I sued the patient on behalf of an assistant surgeon. When the patient raised this claim in Court, I submitted the law requiring an assistant surgeon, the operative report and the doctor’s bill to the Judge. The Court held the patient liable and entered judgment against him. I’m now garnishing his salary.
The Assistant Surgeon is a vital and necessary participant in any operation. His or her bill deserves to be paid.