Over the last several years, patients have been bearing the brunt of the first dollars coming off the top for their care, says Stanford Plavin, MD, ASCA Board member, an anesthesiologist and owner of consulting firm Technical Anesthesia Strategies and Solutions in Atlanta, Georgia. “As insurance plans have transitioned from low co-pays and low deductibles with good out-of-network benefits to higher co-pays and higher deductibles with little to no out-of-network benefits, patients are receiving what they perceive as inordinate bills. They might not have been previously privy to these bills, but they have essentially been around all along. That is where the ‘surprise’ comes in.”