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Resolution: Initially, the Benassos ignored the missive. Izzy Benasso shows her scar from the surgery she had to repair a torn meniscus. Colorado Consumer Health Initiative, which helps consumers dispute surprise bills, has seen a lot of cases involving surgical assistants, said Adam Fox, director of strategic engagement. But state protections donвЂ™t apply to the 61% of American workers who have self-funded employer plans. The researchers found 13% of arthroscopic meniscal repairs resulted in surprise bills, at an average of $1,591 per bill.Д¬olorado has surprise billing protections for consumers like the Benassos who have state-regulated health plans. Of those, 37% are from surgical assistants, tied with anesthesiologists as the most frequent offenders. вЂњTheyвЂ™re not interested,вЂќ said Luis Aragon, a Chicago-area surgical assistant and managing director of American Surgical Professionals, a private equity-backed group in Houston.Д¬hhabra and his colleagues at the University of Michigan recently found that 1 in 5 privately insured patients undergoing surgery by in-network doctors at in-network facilities still receive a surprise out-of-network bill. Surgical assistants counter that many insurance plans are unwilling to contract with them. 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. Indeed, under anesthesia for surgery, patients are often unaware the assistants are in the operating room. Private equity firms often target segments of the health care system where patients have little choice in who provides their care.

вЂњThis is an emerging area of business.вЂќДЄnd it can be lucrative: Some of the larger surgical assistant companies are backed by private equity investment. Karan Chhabra, a surgeon and health policy researcher at the University of Michigan Medical School. вЂњWeвЂ™re seeing more of the third parties,вЂќ said Dr. Karen Ludwig, executive director of the Association of Surgical Assistants, estimates that 75% of certified surgical assistants are employed by hospitals, while the rest are independent contractors or work for surgical assistant groups. вЂњWe had never read or heard of anything like that before,вЂќ Steve says. The letter, from Eric Griffith, a Denver-based surgical assistant, stated it was вЂњa courtesy to remind you of my presenceвЂќ during IzzyвЂ™s surgery. Steve Benasso says he was perplexed after receiving a letter from the surgical assistant who was in the operating room during daughter Izzy BenassoвЂ™s knee surgery. UC School of Medicine, the surgeonвЂ™s employer, declined requests for comment from Genuario. Neither the assistant nor the surgeon works directly for the hospital. Meniscus repair is on the list of allowed procedures.ДЄ Sky Ridge spokesperson said that it is the responsibility of the surgeon to preauthorize the use and payment of a surgical assistant during outpatient surgery, and that HealthOne hospitals do not hire surgical assistants. Surgeons generally decide when they need surgical assistants, although the Centers for Medicare & Medicaid Services maintains lists of procedures for which a surgical assistant can and cannot bill. But some doctors rely on certified surgical assistants, who generally have an undergraduate science degree, complete a 12- to 24-month training program, and then pass a certification exam. Oftentimes other surgeons or physician assistants - or, in teaching hospitals, medical residents or surgical fellows - fill that role at no extra charge. Surgical assistants serve as an extra set of hands for surgeons, allowing them to concentrate on the technical aspects of the surgery. Steve Benasso said he was perplexed by the letterвЂ™s meaning, adding: вЂњWe had never read or heard of anything like that before.вЂќ

#FIRST ASSISTANT FREE#

Subscribe to KHN's free Morning Briefing. The Patient: Izzy Benasso, a 21-year-old college student covered by her motherвЂ™s Cigna health plan. Then the letter arrived, portending of bills to come. вЂњSo that was depressing.вЂќ But she was heartened to hear that with time and rehab she would get back to her active lifestyle.

вЂњI had already gotten a ski pass at that point,вЂќ she said.

Isabel met with GenuarioвЂ™s physician assistant on Wednesday, and the following day underwent a successful meniscus repair operation. вЂњWe were pretty conscious going into it,вЂќ he said. James Genuario and GenuarioвЂ™s clinic were in her Cigna health planвЂ™s network. Steve had double-checked that the hospital the surgeon, Dr. Her father, who works in human resources, told her exactly what to ask the clinic regarding her insurance coverage. вЂњJust sitting there thinking about all the things she wasnвЂ™t going to be able to do.вЂќДЄt the UCHealth Steadman Hawkins Clinic Denver, the MRI confirmed the tear, and she was scheduled for surgery on Thursday. вЂњIt was kind of emotional for her,вЂќ said her father, Steve Benasso.

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