Hospitals and doctors won’t be able to hit Virginia patients with charges their insurers won’t cover -- sometimes totaling tens of thousands of dollars -- after the General Assembly passed legislation to ban such “balance billing.”
The effort took two years and pitted some of the most influential lobbies, health care providers and insurers, against one another over who should pay the difference when a doctor or hospital doesn’t belong to an insurer’s network and therefore doesn’t agree to accept the fees an insurer pays.
The bill says patients can’t be stuck with the difference when they go to the emergency room or need surgery.
Instead, insurers will have to offer out-of-network providers the usual commercial rate for services, which tends to be close or identical to what in-network providers get.
If the doctor or hospital doesn’t like that offer and can’t reach an agreement with the insurer within 30 days, both sides will make their cases to an arbitrator, who will decide the amount. And the provider can’t send the patient a bill for the difference between that and their sticker price -- a practice that gave rise to the term balance billing.
This is the approach that Washington state uses, state Sen. Barbara Favola, D-Arlington, told the Senate.
It is the result of weeks of negotiation between health care providers, insurers, the Virginia Poverty Law Center and the State Corporation Commission, she added.
Favola said the compromise will mean fair payments to doctors and hospitals while addressing insurers’ concerns that simply paying out-of-network providers’ charges in full would discourage them from joining insurance networks and so would push premiums higher.
“Virginians should be able to go to the emergency room or schedule a required surgery without worrying about a medical bill that is beyond their expected deductible or co-pay,” she said.
House Appropriations Committee chairman Luke Torian, D-Prince William, whose balance billing legislation was one of the bases for the compromise, said patients should be able to get care without getting a surprise bill afterwards.
“Surprise bills can cause financial instability for Virginia families and unfairly put patients in the middle of provider-insurer disputes,” he said in a statement.
The House of Delegates and state Senate have each unanimously passed bills amended with the same wording, so the compromise now goes to Gov. Ralph Northam to be signed into law.
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