Surgical Assistants Are Earning 25 Times More Than the Surgeons They Help by Exploiting the No Surprises Act

A Law Written for Patients Is Paying Out to Assistants

The No Surprises Act passed in 2020 with one goal: stop hospitals from blindsiding patients with huge bills from out-of-network providers during emergencies. By June 2026, it has a second, unintended effect. It is making surgical assistants very, very rich.

The New York Times published an investigation on June 29, 2026 titled "$22,000 Per Hour: Assistants Use a Legislative Loophole to Outearn Surgeons." The numbers in it are startling.

Across the country, surgical assistants — who are often nurses or physician assistants, not physicians — are earning up to 25 times what the lead surgeon makes on the same operation, according to data reviewed by the Times and interviews with health plan administrators. The standard industry rate for an assistant is 16 percent of the surgeon's fee. These arbitration awards are not 16 percent. They are not even close.

The March Case in Dallas

In March 2026, a surgical assistant in Dallas received $50,456 through arbitration for assisting on a prostate removal. The surgeon who performed the procedure and accepted the patient's insurance earned $1,843 for the same case, according to the Times.

Brady Connaughton, a New Jersey lawyer who advises union health plans, told the Times the situation is "crazy" and called it "a very blatant disregard of both the spirit of the law and what the law says."

Luis Aragon, CEO of Illinois-based Surgikal Assistants, went further. He acknowledged that very large arbitration awards for assistants are "signs of a system gone awry." His words: "$100,000, $50,000, all these amounts are way out of line. And that is not sustainable for health care costs."

The Lenox Hill Pattern

The Times also reviewed records from Lenox Hill Hospital in Manhattan involving Dr. Shari Reitzen-Bastidas, who frequently assists her husband, Dr. Nicholas Bastidas, on facial feminization surgeries.

In one case, arbitrators awarded Dr. Reitzen-Bastidas $210,000 for assisting on an operation to reshape bones around the eyes. Dr. Bastidas, the lead surgeon, earned $12,767 for the same procedure. Across multiple cases reviewed by the Times, she earned between six and 224 times what her husband made as the primary surgeon.

No law has been broken on its face. Dr. Reitzen-Bastidas was out-of-network and filed for arbitration as the statute permits. But the pattern of a spouse systematically filing for arbitration on procedures led by the other spouse raises questions the law's architects never anticipated.

The Design Problem

Legislators who wrote the No Surprises Act were focused on emergency situations: a patient rushed to the ER who has no say in which providers treat them. The Times found that many cases now flowing through arbitration involve scheduled, elective operations planned well in advance, where the patient, the surgeon, and the assistant all had time to negotiate in-network rates and chose not to.

The arbitration system, meant to be a last resort for genuine emergencies, has attracted a cottage industry of providers and intermediary firms that submit high-volume claims, including ones the Times describes as ineligible, to extract maximum payouts.

The Strongest Defense of the Current System

Supporters of the existing arbitration process make a legitimate point: out-of-network providers gave up contractual rate guarantees, and the arbitration system exists precisely so they can recover fair market value rather than being forced to accept whatever insurers unilaterally decide to pay. Health insurers are not neutral actors here. They have every financial incentive to suppress reimbursement rates, and in the years before the No Surprises Act, providers routinely argued that insurer payment offers were far below actual market rates. The arbitration process, in that view, is a correction to insurer monopsony power, not an abuse of it.

That argument has merit in genuine arms-length disputes. It has significantly less merit when an assistant is collecting $210,000 for assisting on a procedure while the lead surgeon collects $12,767, or when assistants are systematically pairing with surgeons who happen to be their spouses.

What Comes Next

The AHIP, which represents health insurers, flagged the Times investigation on June 29, 2026 as further evidence of what it calls provider-driven abuse of the arbitration system. The organization has a direct financial interest in lowering arbitration payouts, so its framing should be weighed accordingly. But the specific numbers the Times independently reviewed tell a consistent story.

Congress built the arbitration mechanism as a stopgap. It never funded a robust eligibility-screening system to catch ineligible claims before they enter the queue. The unresolved question, as of June 29, 2026, is whether legislators will narrow the law's arbitration eligibility rules to cover only genuine emergencies — or whether the lobbying power of out-of-network provider groups will keep the loophole open long enough to make it permanent infrastructure.