A law meant to shield patients from shocking medical bills is instead generating eye-popping payouts for some surgical sidekicks. The New York Times reports that bedside assistants—sometimes other doctors, but often nurses or physician assistants who help surgeons operate robots, retract skin, and sew up incisions—are sometimes collecting tens of thousands of dollars per case through a federal arbitration system created by the 2020 No Surprises Act. In some instances, they're making up to 25 times what the lead surgeon is paid. The law bars most out-of-network surprise bills to patients and pushes payment disputes into arbitration, where federal contractors choose between the insurer's offer and the provider's. Providers win more than 85% of the time, and a subset of surgical assistants, or the companies that employ them, have turned that into a lucrative strategy.
Examples include a Dallas assistant paid $50,456 for prostate surgery when the surgeon received just $1,843 via insurance; a New York facial feminization assistant who has secured at least $1.4 million since 2025; and a New Jersey assistant who made $111,000 on a breast reconstruction, which came out to roughly $22,000 an hour. When the law was initially passed, the feds figured they'd see 17,000 claims annually; the actual number has been 6 million cases over the past four years. "This is the road-to-hell-is-paved-with-good-intentions legislation," says one attorney who offers counsel for union health plans. Health plan officials warn that the incentives could push more clinicians out of insurance networks and drive premiums up, while even some benefiting from the system call six-figure awards "not sustainable." More here.
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