1. Who is Surgbill, Inc.?
We are a medical billing company that contracts with providers
nationwide, specifically Surgical Assistants, to submit claims to
insurance payors in their behalf. We are not a collection agency, we
only process and submit medical claims to insurance companies and
send statements to patients for the portion that the insurance
company stated that is their responsibility.
2. What is a Surgical
A Surgical Assistant is a highly skilled individual, providing quality peri-operative care to patients, who has received specialty training in surgical assisting
Physicians and/or surgeons
Formal training in surgical assisting from universities, hospitals, private schools, allied health organization programs
Military training in specialty programs, operating rooms and in the field
Foreign medical school graduates working in the United States
with proper national certification.
Hospital operating room staff members trained by surgeons in the operating room (registered nurses, physician assistants)
A Surgical Assistant should not be
confused with a "Surgical Technician", a surgical tech is the member of the OR
team provided by the facility to hand out instruments to the surgeon and his/her
assistant during the operation.
3. Why am I getting a bill from
As stated above, we are contracted by the Surgical Assistant in your surgery to
submit the medical claim, after reviewing the claim, your insurance company has
determined that you are responsible for the amount in your statement, your
payment should not be made to us, it should be made to the surgical assistant in
your procedure, we will forward your payment to him/her in a timely fashion.
4. Why did my surgeon utilize a
After thoroughly reviewing your medical history and the surgical procedure that was to be performed, your surgeon determined that a
Surgical Assistant was medically necessary.
5. Why didn't my surgeon tell
me he was going to use a Surgical Assistant?
The decision of what to discuss with the patient prior to surgery is a personal matter between the surgeon and the patient. Many surgeons advise their patients prior to surgery. However, some surgeons do not wish to burden their patients with any additional information that they feel would not be vitally important for their patient's impending surgery and recovery. Your surgeon made many similar pre-operative decisions, such as choices of anesthesia, type of instruments, surgical supplies to use, which he or she may or may not have discussed with you prior to your surgery.
6. Why did my surgeon use a
provider not in my network?
Unfortunately, most surgical assistants are not participants in every PPO and
HMO at this time, and this is due mainly because insurance companies do not want
to accept them as providers. Being this said, if your insurance company does not
contract with surgical assistants in your area, you can appeal their
determination and most plans will cover these services if in fact they do not
have any surgical assistants in their network because obviously this is not your
fault. However at this moment the only person that can make this appeal to the
insurance is you as their member.
7. My insurance company said
that a Surgical Assistant was not medically necessary.
Insurance companies often make their determination of medical necessity on the basis of their overall average experience with many surgeons and many patients over a period of time, rather than on a specific individual patient's situation. In any event, the use of a surgical assistant is always at the discretion of the surgeon. In your particular case, your surgeon felt that an assistant was medically necessary.
8. Why is my insurance company not
covering the services of a Surgical Assistant?
Each insurance company and each individual plan has their own itemized list of covered benefits and non-covered items. Most insurance companies do cover the charges for a surgical assistant. You may wish to review your individual insurance plan policy and discuss the exclusion of this particular service with a representative of your insurance carrier, your employee benefits administrator, your human resources manager, or your employer, as appropriate.
9. My insurance company said that the Surgical Assistant
in my procedure is not licensed in the State where my surgery was performed. Does this mean that this individual is not qualified or trained?
As of right now only Texas, Illinois and Kentucky license Surgical Assistants,
in other States Surgical Assistants should be certified by either on of the
following national bodies:
National Surgical Assistant
American Board of Surgical
National Board of Surgical
Technology and Surgical Assisting
Association of Operating Room
10. Why are surgical assistant not licensed in my State?
Your State legislators have determined that because Surgical Assistants are
under the supervision of licensed physicians and registered nurses at all times,
regulating them does not offer any additional patient safety. Most States have
some kind of regulation legislation in their agenda and will probably pass at
some point or another.
11. Will you file a review or appeal to my insurance company if the charges are denied?
Yes. We regularly perform this service as a courtesy to our referring
providers and their patients. However, we cannot guarantee that your insurance carrier will change their payment determination.
If you already have received a statement, this means that all appeal efforts
have been exhausted with your insurance provider.
12. Can I make payment arrangements?
Yes, certainly. Please call our direct line (815) 464-2953 to make payment arrangements. We can work with you to arrive at a comfortable budget for you.
13. Why do I have to pay for a surgical assistant when I did not authorize this? Since my surgeon is the one who asked
this individual to provide the service, he or she should pay for it.
The hospital policy regarding this is stated on the surgical consent form. This form explains that certified surgical assistants may be called to help with an operation. The need for an assistant cannot always be predicted. When you selected your surgeon, you relied upon his or her good judgment and skill to make decisions that were in the best interests of your health and well-being. There are many decisions that your surgeon made on your behalf in the process leading up to your surgery, the actual performance of your surgery, and the immediate recovery period following your surgery. As a practical matter, your surgeon was unable to discuss each of these decisions with you, the patient. After thoroughly reviewing your medical history and the surgical procedure that was to be performed, your surgeon determined that it was in your best interest for the safest possible performance of your surgery to have a surgical assistant present during your surgery. This would be similar to asking the surgeon to pay for any anesthesia or medications that were not authorized by you.
14. I have Blue Cross Blue Shield insurance. Why are you sending me a bill?
We file your claim with Blue Cross Blue Shield. However, since some States do not license surgical assistants, we do not have a license number or a BCBS provider number. Therefore, BCBS does not send payment or an explanation of benefits to us. They will send any payment to you. You can sign the back of the check BCBS sends to you and mail it along with a copy of the Explanation of Benefits to:
342 N. La Grange Rd. Ste. 322
Frankfort, IL 60423
If you do not hear from BCBS in a reasonable period of time, please follow up with them directly.
15. Did you bill my insurance?
We usually receive insurance information from the Hospital where you had your surgery
directly from your provider. If the information is complete, we will use that information to send a claim to your insurance carrier. If you wish to verify that the information we have is accurate & complete, please fill out the back of the stub that came with your bill giving us full insurance information, including your identification number, your group number, and the name of the insured person and his or her date of birth. It is very helpful to send us a photocopy of the front and back of your insurance card. This way, if we do not have complete and accurate information, we can promptly correct our files, submit a claim to your insurance carrier in a timely manner, and avoid any delays in the payment of your bill.