Summary:

Surgical assistants are exploiting the No Surprises Act, a law meant to protect patients from surprise out-of-network bills, to win huge arbitration payouts—sometimes up to 25 times what the operating surgeon makes, versus the standard insurer fee of 16% of the surgeon’s pay. 

How it works: out-of-network assistants file for arbitration (intended for emergency situations) instead of accepting normal insurance rates, and arbitrators often grant inflated awards. In one case, a Wisconsin practice split a 2024 spinal fusion surgery into 11 separate bills, winning $196,215 total in arbitration ($125,058 to the surgeon, $70,707 to his assistant) versus a typical payout of about $9,310 and $1,562 respectively. 

In another, a Manhattan surgical assistant married to the operating surgeon has earned 6 to 224 times his pay on procedures they perform together.

Patients aren’t affected directly (they still pay normal in-network rates), but insurers say these payouts are driving up premiums for everyone. Even some assistants who benefit from arbitration call the largest awards “way out of line” and unsustainable for healthcare costs.

$22,000 Per Hour: Assistants Use a Legislative Loophole to Outearn Surgeons