By Mariah Taylor

Some surgical assistants are earning 25 times what the surgeons make thanks to arbitration laws.

Here is what to know.

1. Surgeons and surgical assistants have been capitalizing on the arbitration rule inside the No Surprise Act. The 2020 law is intended to protect patients from surprise billing by providers outside their insurance plan, and was meant to apply to emergency and unscheduled care. It allows out-of-network surgeons and assistants to dispute an insurer’s payment through arbitration. Each side submits a proposed price, and a federal contractor picks whichever offer it judges more reasonable. This structure gives providers an incentive to ask for far more than standard rates, since arbitrators have sided with providers in the large majority of cases. Overall, physicians win more than 85% of arbitrations and significantly higher payouts. One physician earned $440,000 for a routine breast reduction.

2. Typically, surgical assistants are paid a standard fee of 16% of the surgeon’s earnings. However, some are opting to file separately from physicians for arbitration and win far greater awards than what an in-network assistant would normally receive, in some cases more than the surgeon they assisted, according to the report.

3. In March, a Dallas surgical assistant earned $50,456 through arbitration for a prostate removal operation — meanwhile the surgeon on the case earned $1,843.

4. These surgical assistants are sometimes physicians, but more often they are nurses or physician assistants.

5. Patients are often unaware if their case was taken to arbitration, and pay what they normally would for an in-network provider. But the extra cost is passed onto patients as higher premiums. TeamCare, a health plan that covers half a million union workers, has spent $19 million on arbitration cases since 2022.

6. Physicians group argue that insurers often offer payments too low for physicians managing complex cases. Surgical assistant groups said that health plans often refuse to let them into the networks, leaving them with unpredictable and low payments.