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In Virginia, Patients May Not Need to Worry About Surprise Medical Bills Anymore

Medical bill and calculator
(Photo: edar from Pixabay)

After many years of discussion and debate, lawmakers approved legislation Thursday to protect Virginia patients from medical bills from out-of-network providers: both in the ER, and for scheduled procedures. 

The law will protect Virginians from what’s commonly known as “balance billing,” when a patient receives a surprise medical bill after being treated by a provider not covered by their insurance plan. 

“Surprise bills can cause financial instability for Virginia families and unfairly put patients in the middle of provider-insurer disputes,” said Del. Luke Torian (D - Prince William), who sponsored the legislation, in a statement. “I am proud we were able to come to a compromise that takes patients out of the middle, ensures doctors are reimbursed for the care they provide, and protects Virginia families.”

The approved legislation is based on a model out of Washington state, and is a complete rewrite of what Virginia lawmakers had initially proposed. It sets up a system for insurance companies and out-of-network doctors to work out a payment plan, so patients are no longer on the hook for the bills. 

First, insurers offer doctors their median, in-network rate. If the providers say no, insurers can offer a higher, “commercially reasonable” rate.

“And if the out-of-network doctor still doesn’t like that, then they can go to arbitration,” said Jill Hanken with the Virginia Poverty Law Center. “The important thing is that the consumer is left out of this process.”

The insurer and provider would have to split the cost for the third-party arbitrator, who’d help work out a reasonable payment as a last result. If one party still refuses to accept the arbitrator’s proposal, that party would be on the hook for the full cost of the arbitrator’s fees, Hanken said. 


Megan Pauly reports on early childhood and higher education news in Virginia
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