Surgical Assistants Secure Payments Up to 25 Times Surgeons’ Fees Through Arbitration

Surgical assistants—who position robotic arms, manage suction, and exchange instruments during procedures such as prostatectomies—are receiving compensation far beyond the standard rate. While most health insurers pay assistants a fee equal to roughly 16 % of a surgeon’s earnings, data reviewed by *The New York Times* show that some assistants are earning as much as twenty-five times what the operating surgeon receives. The disparity emerges from the use of arbitration under a federal law designed to address surprise medical bills.

New York Times

The relevant statute was enacted to protect patients from “surprise billing” when they receive care from out-of-network providers. Under the law, providers who are not in a patient’s insurance network may submit their claims to an arbitration process. The arbitration panel can then award payments that exceed the amounts insurers would otherwise approve. Although the law’s primary goal is patient protection, the arbitration mechanism also creates a pathway for providers—such as surgical assistants—to argue for substantially higher fees.

New York Times

A typical prostate removal operation takes about three hours. In most cases, the assistant’s fee is set at 16 % of the surgeon’s earnings. However, the reviewed data reveal outlier payments. In March, a surgical assistant in Dallas received $50,456 through arbitration for a single prostatectomy, while the surgeon who performed the operation earned $1,843. This example illustrates a payment ratio of roughly 27 to 1, far exceeding the usual 16 % share and confirming that assistants can earn up to twenty-five times the surgeon’s fee in certain arbitration outcomes.

New York Times

Officials from large health-plan administrators, interviewed for the investigation, acknowledge that the arbitration process permits assistants to present detailed cost arguments that can result in higher awards. They note that the arbitration system operates within the legal parameters of the surprise-billing law and that the higher payments are a direct consequence of the providers’ ability to substantiate their claims during the arbitration hearing.

New York Times

Critics contend that the arbitration provision, originally crafted to shield patients from unexpected charges, is being leveraged by surgical assistants to secure payments that dwarf the fees intended for their role. They argue that this exploitation undermines the law’s protective intent and may contribute to rising healthcare expenditures without delivering commensurate clinical benefit.

New York Times

The investigation acknowledges limited access to the full article content and a broader dataset on arbitration outcomes. Consequently, the prevalence of extreme assistant payments across the nation remains unclear. Additional research is needed to determine how widespread the practice is and to assess its impact on overall surgical costs.

New York Times