·       Who is Mederi Services, LLC?

We are a medical billing company that contracts with healthcare providers nationwide to submit claims to insurance companies on 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 as requested by the provider.

·       What is a Surgical Assistant?

A Surgical Assistant is a highly skilled individual, providing quality peri-operative care to patients, who has received specialty training in surgical assisting through formal, informal and on the job training.

·       Why am I getting a bill from you?

We are contracted by the Provider in your surgery to submit the medical claim, after processing 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 providers address listed on the statement.

·       Why did my surgeon utilize an Assistant?

After reviewing your medical history and the surgical procedure that was to be performed, your surgeon determined that an Assistant was medically necessary for your safety and wellbeing. 

·       Why didn't my surgeon tell me he was going to use an Assistant?

This is a decision that is usually made by the surgeon, who may or may not feel that such technical detail needs to be discussed with you. It is similar to many other technical issues which they may or may not have discussed with you prior to your surgery.  However, for your safety and for a good outcome to the procedure, they may decide there is a need for certain a service or providers to get involved in your care.

·       Why did my surgeon use a provider not in my network?

Most assistants are not participants in every PPO and HMO mainly because insurance companies do not want to accept them as providers. 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 because they do not have any surgical assistants in their network. You may need to make this appeal to the insurance is you as their member.

·       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. The use of an assistant is always at the discretion of the surgeon.  Your surgeon felt that an assistant was medically necessary.

·       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.

·       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.

·       Can I make payment arrangements?

Yes, certainly. Please email us at info@mederiservices.com or call us at 877-563-3374 to make payment arrangements.  We will contact the provider and help work out payment arrangements.

·       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 should be 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.

·       Did you bill my insurance?