Question:
The surgeon I used for my open RNY uses an assistant during surgery.
I had to pay the asst fees upfront and then the office filed with insurance. The dr office filed it as "assistant surgeon" and the claim was denied. When I went for my 1mth visit, I noticed the asst had the initials P.A. on his office and white coat. Doesn't this mean he is a Physician's Assistant? My ins would cover this, but not at the full amt charged. Is this a normal practice? — Wendy S. (posted on July 3, 2003)
July 2, 2003
PA does = physican assistant. As far as is this normal??? It varies. My
surgeon did not use an assistant. I recently had a hernia repair where the
surgeon used a SA (surgicAL assistant) alot of these surgeons hire
'helpers' and then try to submit as "assistant surgeons" ONLY
MD's can submit as a 'assistant surgeon'. Some times, depending on 'the
procedure' you can get 'rn's , maybe pa? covered depends on your insurance.
WHAT is happening; is the surgeons dont want to use the hospital 'or' staff
(which is covered) and personally dont want to pay for their own
assistant... so they are getting patients to pay them. At least yours told
you up front. MINE didnt; and I plan to file with the BBB association
about this.
— star .
July 2, 2003
Oh my gosh! I had the EXACT same thing happen to me yesterday! I got my
explanation of benefits from BC/BS and it denied a charge of $1500 for a
Physician's Assistant. I was ticked off!!! At no point did my surgeon
tell me that there was going to be a $1500 charge for his PA. Very, very
irritated with the situation and I plan to discuss it with them at my
appointment in two weeks.
— Cheryl M.
July 2, 2003
I went through the same thing.. all though it was a surgical assistant in
with my doctor... I had to pay 800.00 up front as I heard so many
insurances wouldn't cover the cost. Insurance companies don't believe it
takes 2 to preform the surgery... I was told if my insurance approved it i
would receive a refund... well, I have yet to see it, but I figured it was
money well spent. I withdrew it from my 401k plan at work... and paid a
penalty for early withdrawl... but again... the surgery saved my life, so
it was worth every penny
— Peg L
July 3, 2003
It is my understanding the an assistant in only needed in the in the
Laproscopic RNY not the Open RNY. I would question this if I were you. If
you have PPOof some type the only reason you should have to pay so much is
if they used a P.A. that was not in you network.
— E. V.
July 3, 2003
Talk to your surgeon, initially my insurance paid the surgeon but not the
aneastologist. Yeah sure have surgery while awake:( Eventually the fixed
the paperwork.
— bob-haller
July 3, 2003
I don't know who was what in your case, but I do know that no surgeon
should EVER operate with out an assistant. If I had a surgeon who was
planning to operate with out a qualified assistant I would get off the OR
table and walk out of there. what if you Dr. became ill during your
surgery? think It cant happen, A Dr. I used to work with burst an aneurism
in the brain while on duty.
— **willow**
July 3, 2003
As far as how the surgery was coded: It is dependent on the modifier added
on to the end of the code. -80 for assistant surgeon or -82 for assistant
surgeon (when qualified resident surgeon not available) Most surgeons use
a resident (or 2), who would be paid salary by the hospital. If your
surgeon routinely uses a P.A. and your insurance doesn't want to pay for
it, then yes, this will be a normal practice with your surgeon. They knew
it would be denied, so they asked for the $$ up front. E.V.: NO SURGEON
does abdominal surgery without some kind of assistance! Even in an open
surgery, they need help getting the retractors into the abdomen of even a
thin person (imagine difficulties of obese pts!), they need help holding
different parts 'n' pieces out of the way, suctioning, etc...
— Lori A.
July 3, 2003
Hi Wendy,
I have Horizon Direct Access (BCBS of NJ). My insurance covered the doctor
and an assistant. You should put a call into your insurance company to find
out if yours does. They should be able to tell you this when you call.
Since this type of surgery is something that requires the doctor to have an
assistant, I would think you should be o.k. Good luck!
— Ceil G.
July 3, 2003
Using a P.A. (physician's assistant) is very common in open RNY.
— Lynette B.
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