1WHO IS PHENOM SURGICAL, LLC?
Phenom Surgical LLC is an independent supplier of Surgical First Assistants for facilities. We supply Certified Surgical Assistants, Surgical Technologists, Physician Assistants and Registered Nurse First Assistants to surgeons and hospitals in the Northern Virginia area.
2WHAT IS A SURGICAL ASSISTANT?
Surgical Assistants are highly skilled individuals, providing quality peri-operative care to patients. They have received specialty training in surgical assisting through: • 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). The Surgical Assistant is expected to anticipate the needs of the surgeon, solve problems and perform significant surgical tasks in the proper sequence without distracting the surgeon from the performance of the surgical procedure.
3WHY DID MY SURGEON UTILIZE A SURGICAL ASSISTANT?
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. The use of Surgical Assistants is at the discretion of the surgeon.
4DID PHENOM SURGICAL BILL MY INSURANCE?
Yes. We receive insurance information 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
5WHY HAS MY INSURANCE COMPANY DETERMINED THAT A SURGICAL ASSISTANT WAS NOT MEDICALLY NECESSARY?
The use of a Surgical Assistant is always at the discretion of the surgeon. In your case, your surgeon felt that an assistant was medically necessary to provide optimal care for you. You may wish to review your individual insurance plan policy and discuss the exclusion of this specific service with a representative of your insurance carrier, your employee benefits administrator, your human resources manager, or your employer, as appropriate.
6MY INSURANCE COMPANY SAID THAT THE SURGICAL ASSISTANT IN MY PROCEDURE IS NOT LICENSED DOES THIS MEAN THAT THIS INDIVIDUAL IS NOT QUALIFIED OR TRAINED?
Phenom Surgical providers are all highly qualified and are currently certified by one of the following national bodies: • National Surgical Assistant Association • American Board of Surgical Assistants • National Board of Surgical Technology and Surgical Assisting • Association of Operating Room Nurses Currently only Texas, Illinois, Kentucky and the District of Columbia license Surgical Assistants. However, Virginia Senate Bill 328 was recently passed to require registry of Surgical Assistants and Surgical Technicians with the Virginia Board of Medicine.
7MY INSURANCE IS BLUE CROSS BLUE SHIELD (BCBS). WHY ARE YOU SENDING ME A LETTER?
Phenom Surgical does not participate with BCBS and is therefore, considered an out-of-network provider. Reimbursement for services rendered by out-of-network providers is paid directly to you, the member. Phenom Surgical filed your claim with Blue Cross Blue Shield (i.e., Anthem BCBS or CareFirst BCBS depending on where the services were rendered). After your insurance company processes the claim, they will send you an explanation of benefits (EOB) and check for our services. Phenom Surgical agrees to accept the paid amount as payment in full. When the check is received, please sign the back of the check, make payable to “Phenom Surgical, LLC” and mail it along with a copy of the EOB to: Phenom Surgical, LLC 8116 Arlington Blvd, Suite 183 Falls Church, VA 22042-1002 If you do not hear from BCBS in a reasonable period of time, please follow up with BCBS directly. If you have any questions, our billing department can be reached on our direct line (703) 659-4557 ext. 4.