The city was founded in 1938 by Flora Mae Statler, who named it Surprise as she "would be surprised if the town ever amounted to much." Surprise officials previously thought the city was founded by Statler's husband, real estate developer and state legislator Homer C. Ludden, but in 2010 property records were discovered which listed Statler owning the land before she met Ludden.
Data on the prevalence of surprise medical bills and costs to consumers are limited. The Affordable Care Act (ACA) requires health plans in and out of the Marketplace to report data on out-of-network costs to enrollees, though this provision has not yet been implemented.2 Research studies offer some clues as to the prevalence and cost to patients due to surprise medical bills:
Policymakers at the federal and state level have expressed concern that surprise medical bills can pose significant financial burdens and are beyond the control of patients to prevent since, by definition, they cannot choose the treating provider. Various policy proposals have been advanced, and some implemented, to address the problem. These include hold harmless provisions that protect consumers from the added cost of surprise medical bills, including limits or prohibitions on balance billing. Others include disclosure requirements that require health plans and/or providers to notify patients in advance that surprise balance billing may occur, potentially giving them an opportunity to choose other providers.
Several federal standards have been adopted or proposed to address the problem of surprise medical bills in private health plans generally, in qualified health plans offered through the Marketplace, and in Medicare. These standards vary in scope and applicability:
Surprise medical bills can contribute significantly to financial burden and medical debt among insured individuals, though data on the incidence and impact of this problem are limited. Federal authority to track the incidence and impact of surprise medical bills exists but has not yet been implemented.
Policy makers have considered and adopted various responses, yet tradeoffs are involved in protecting consumers from surprise bills. There is concern among some as to whether or how new consumer protections might affect insurance premiums. Establishing requirements both on what health plans must cover and on amounts that out-of-network providers can bill can limit the impact on premiums, though providers may balk at restrictions on how much they can charge.
The problem of surprise medical bills is likely to continue, and may increase to the extent plans create narrower provider networks. The very nature of the problem means that consumers will be hard pressed to take action to avoid surprise medical bill situations absent intervention by policy makers.
3) Improve transparency and notice to patients about out-of-network situations and charges, but recognize that improved transparency and voluntary efforts alone will not eliminate situations of unfair surprise.
Although the best remedies for surprise billing can be controversial, the controversy should not deter lawmakers from crafting a solution that holds patients financially harmless when they take reasonable steps, or have no reasonable opportunity, to avoid out-of-network billing.
There are two basic options for determining how much health plans should pay nonparticipating providers, keeping in mind the need for administrative feasibility and to avoid unduly distorting market dynamics: regulate provider rates in surprise situations; or mandate a form of a dispute resolution.
This court's order did not affect any of the Departments' other rulemaking under the No Surprises Act. Thus, consumers continue to be protected from surprise bills for out-of-network emergency services, out-of-network air ambulance services, and certain out-of-network services received at in-network facilities. The patient-provider dispute resolution process for uninsured and self-pay consumers to dispute bills that exceed a provider's or facility's good faith estimate by $400 or more also remains available and unchanged by the court's order. To learn more about these protections, visit www.cms.gov/nosurprises. 041b061a72