Surgical Assistant's Presence During Knee Repair Leads To A Costly Surprise Bill : Shots - Health News A college student's bill for outpatient knee surgery is a whopper — $96K — but the most mysterious part is a $1,167 charge from a health care provider she didn't even know was in the operating room.

The Knee Surgeon Was In-Network. The Surgical Assistant Wasn't, And Billed $1,167

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Every month, NPR and Kaiser Health News take a close look at medical bills that you send us. And today, we're going to hear about a person called a surgical assistant. As the name suggests, this is someone trained to help a surgeon during certain operations. I want to bring in Elisabeth Rosenthal, who is not a surgical assistant. She is the editor-in-chief of Kaiser Health News.

Hey there, Elisabeth.


KELLY: I am well, thank you. So this is all newly relevant to be talking about because people are starting to have elective surgeries again after months of lockdown. I don't know that I had ever heard of a surgical assistant before. Is this something new?

ROSENTHAL: No, it's not really new. You know, there are some surgeries that take two sets of skilled hands, and so the primary surgeon would often call in an assistant. And sometimes that would be a resident or a kind of surgical assistant that was part of the hospital staff. What is new is that now people are getting billed and billed big for this service.

KELLY: Which is what brings us to bill of the month. Who are we going to meet today?

ROSENTHAL: Today, we're meeting Izzy Benasso and her father Steve. Izzy tore some of the cartilage in her knee and needed an elective knee surgery and ended up with a somewhat surprising bill.

KELLY: All right. And our guide to this is going to be Dan Weissmann, the host of "An Arm And A Leg" podcast, 'cause he talked to the Benassos. So let's listen.

DAN WEISSMANN, BYLINE: Izzy Benasso and her dad Steve were playing tennis last summer when Izzy had to make a big reach for the ball.

IZZY BENASSO: I pivoted really hard, and something didn't feel great. And before I knew it, I couldn't straighten out my legs.

WEISSMANN: She bent over and said, oh, no. Steve wasn't super concerned - at least at first.

STEVE BENASSO: Because she's been a competitive soccer player all her life, I just expected her to bounce back.

WEISSMANN: Izzy says it wasn't even the pain that had her shedding a tear. It was the thought she might have a serious knee injury.

I BENASSO: I've seen quite a few teammates tear ACLs and know what that recovery process was.

WEISSMANN: An MRI brought good news. Izzy's injury, a meniscus tear, would mean an easier recovery. She was in and out of surgery within a week. Izzy headed back to her senior year at college. Steve watched the mail for bills. Before the first one arrived, there was a letter from someone who said he was a surgical assistant.

S BENASSO: It was very cordial, and it basically was explaining that this was not a bill for services, that he had let Cigna, our insurance carrier, know that he was present during Izzy's surgery.

I BENASSO: Like they were just sneaking people in while I was unconscious, and then they could all write letters and say, hey, we were there, too.

WEISSMANN: A month later, a follow-up from the same guy with the same message. And to understand what Steve does next, there's a couple things worth knowing about him. First...

I BENASSO: Steve is the kind of person to check every receipt twice and argue over any discrepancies he finds.

WEISSMANN: Izzy says her family's gotten lots of free stuff as a result, like the supermarket manager who sent over a basket of food and some gift cards.

S BENASSO: That's, by far, not the best one. My wife and I received a free ski trip to Sun Valley once.

I BENASSO: Oh, yes. That one was good.

WEISSMANN: The other thing about Steve is his job. He's a human resource director, and he encourages people where he works to come to him with questions about their medical bills. Anything looks fishy, he goes to battle for them.

S BENASSO: I do it every month.

WEISSMANN: So this weird letter from a surgical assistant - Steve gets suspicious, writes the guy right back to say, I'm guessing you're telling me this so that I'm not surprised to get a bill from you. And I'm also guessing that you don't take our insurance, which is why you're trying to soften me up.

S BENASSO: And I want you to know that I have absolutely no intention of paying your bill. And if you feel that you're owed something for your services, I suggest you take it up with Izzy's surgeon and that you perhaps come to some sort of agreement on how to split the fee that he receives, or you can have the pleasure of arguing this with Cigna yourself. That's essentially what I said (laughter).

WEISSMANN: That letter is hilarious, and it seems to have worked. Steve says he hasn't heard from the guy since - no bill, no nothing.

For NPR News, I'm Dan Weissmann.

KELLY: All right. And I want to bring back in Elisabeth Rosenthal to explain what is going on here. How is it that somebody can try to charge for helping out during surgery?

ROSENTHAL: Well, this is kind of the latest twist on surprise out-of-network billing. And it results from what in the medical field is called unbundling. Stuff that used to be included in your hospital stay is suddenly charged item by item. So, you know, just for an example that we're more familiar with, you go to an emergency room, right? And suddenly, you get a big out-of-network bill from the ER doctor, or you get surgery, and you get an out-of-network bill from the anesthesiologist. This is taking that trend one step further because, hey, you know, she never even met this guy, and she's being billed for an extra set of hands in the OR. You take this to the next stage, and you think, wait; is the nurse who gives me a pill going to be charging a nursing pill delivery fee? I mean, it's really gotten somewhat out of hand.

KELLY: So what can we do about it, aside from finding a Steve Benasso who can write a fierce letter on our behalf? What can we do, Elisabeth Rosenthal?

ROSENTHAL: You can do a lot. If you're going in for an elective surgery, ask if there'll be a surgical assistant involved. And make sure they're in network, just like we've all been trained now to say, is the anesthesiologist in network? - because one of the things that surprised me about this is that surgical assistants have become one of the most common causes of surprise bills.

KELLY: So ask questions, ask questions, ask questions before you write any checks, it sounds like is the lesson here.


KELLY: All right. Elisabeth Rosenthal of Kaiser Health News, thank you so much.

ROSENTHAL: Thank you.

KELLY: And if you are listening and you have an outrageous or confusing or mysterious bill that you want us to take a look at, go to NPR's Shots blog and tell us about it.

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