Virginia is trying again to halt the surprise medical bills patients receive when are they are unknowingly treated by providers outside their insurers’ networks.
The State Corporation Commission will take comments on the proposed regulations until Sept. 1, with the aim to have them become effective Jan. 1.
The rules are to enact legislation that bars out-of-network providers from billing patients for balances above what their insurers pay for emergency services and for non-emergency services, such as anesthesiology, radiology, labs and hospitalists, at in-network facilities.
These balance bills are what some LewisGale Medical Center patients received in the past after the health system contracted with Schumacher Clinical Partners for hospitalists and emergency physicians.
Schumacher agreed to not balance-bill LewisGale patients if the physicians were not in their network, but some people still received bills for the full cost of their care. Patients were confused when their insurers and providers failed to communicate with each other and left them to navigate a complicated process.
The SCC last year attempted to write rules on previous legislation that would have made hospitals responsible for the charges if they failed to inform patients if anyone caring for them was not in their network. That effort was panned by doctors, hospitals and insurers.
This time, under bipartisan legislation by Sen. Barbara Favola, D-Arlington, and Del. Luke Torian, D-Prince William, if out-of-network providers dispute the amount insurers pay, the matter goes to arbitration. Patients will still be responsible for deductibles and co-pays.
“Achieving this victory for Virginia patients and families took many long hours of negotiations with a diverse group of stakeholders who share a common belief that patients should not be burdened with the task of negotiating an outstanding medical bill with their insurance company,” Favola said in a news release. “Patients recovering from medical care should focus on healing, not the emotional and financial anxieties of resolving unexpected, expensive medical bills that can explode household budgets and place families at risk of bankruptcy.”
Dr. Todd Parker, with the Virginia College of Emergency Physicians, said the legislation is not the best for doctors, hospitals or insurers, but is for patients.
“Emergency departments are the safety net of the health care system, and this law guarantees that no person has to worry about receiving a bill for care they rightfully assumed was covered by their insurance,” Parker said in joint release Tuesday by the emergency physicians, the Virginia Hospital and Healthcare Association and the Medical Society of Virginia.