PATIENTS

The Questions They May Have

 

1. Who is S5 Medical Billing, LLC?

S5 Medical Billing, LLC contracts with surgical assistants and medical providers nationwide submitting medical claims to your insurance agency on their behalf. We process and submit medical claims to insurance companies and send statements to patients for the portion that the insurance company stated is their responsibility.

2. Why am I getting a bill from you?

After submitting and reviewing the claim, your insurance company has determined that you are responsible for the amount in your statement. Your payment should be made out to the surgical assistant provider for your procedure.

3. What is a surgical assistant?

The American College of Surgeons defines it this way: “Under the direct supervision of the surgeon, [the surgical assistants] provide aid in exposure, hemostasis, assist during surgery and in the preoperative and postoperative periods and other technical functions that will help the surgeon to perform a safe operation with optimal results for the patient. The assistants set up operating rooms to ensure that all the necessary equipment such as sponges and instruments are available. During surgery, surgical assistants perform duties such as inserting catheters or placing surgical drapes over patients. The assistants also apply wound dressing and monitor patients’ vitals.”

4. Why did my surgeon need to use a surgical assistant?

After reviewing your medical health and 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 beforehand he was going to use an assistant? Moreover, why do I have to pay for a surgical assistant when I did not authorize this?

The hospital has a legal responsibility to inform you about any physical or fiduciary risks that arise from your operation. It does this in a “surgical consent form,” which is given to you prior to surgery. This form typically gives surgeons the discretion to bring in one or more certified assistants to assist before, during, and after your surgery – depending on your particular needs. Keep in mind that if you were unable to make these decisions, they may have been made for you by the health care provider based on exigent circumstances. Hospitals are required by law to treat first and bill later. See the following pages for more information:

6. Why did my surgeon use a provider, not in my network?

Sometimes claims are denied because your insurance plan refuses to reimburse an out of network assistant. Your doctor, not the insurance company, is the one that chooses the assistant – and he or she bases this decision not on whether the assistant is in the network or not, but whether the assistant is available and has the skills to perform a safe and accurate procedure. If your insurance claim is denied because the provider was out of network, you may want to strongly consider appealing their determination. Your state legislature may offer you additional protections.

7. Did you bill my insurance?

We usually receive insurance information directly from your provider from the hospital where you had your surgery. If the information is complete, we will use that information to send a claim to your insurance carrier in a timely manner, and avoid any delays in the payment of your bill.

8. Will you file a review or appeal to my insurer if the charges are denied?

If your insurance denies the provider reimbursement for the services of a surgical assistant, we automatically appeal the claim if applicable. (Not every case is appealable.) You receive a bill when we’ve exhausted all of our options. We may possibly be able do more once you formally appeal to your insurance provider. Keep in mind that you’re the one paying the premiums, and your position holds great weight in your dealings with them.