Lawmakers hear bills to protect patients from balanced billing

Bill would make "Balance Billing" illegal

RICHMOND, VA (WWBT) - Several bills which would make balance billing patient illegal went before lawmakers Thursday afternoon.

A House of Delegate subcommittee on Commerce and Labor heard the handful of bills dealing with balance billing for emergency and regular services.

Balance billing is where providers bill patients the difference between the provider’s charge and the allowed insurance amount.

In July 2018, Sally Matchett contacted 12 On Your Side after she was blind-sided by a separate bill from the physician who treated her during her emergency room crisis.

“I had gone to an in-network hospital but didn’t even think some of the doctors could be out-of-network,” Matchett said.

Matchett said she was treated and then released but was shocked when she received a bill for $1,180 by her Cigna Insurance, which showed coverage denied for the ER doctor.

“It’s not fair how it went down,” she said. “It was almost sneaky. I was not notified.”

On Thursday, Matchett, along with doctors from the Virginia College of Emergency Physicians, advocated for Delegate Lee Ware’s HB 1714, which looks to change part of Virginia law to ensure more protections for patients dealing with emergency services.

“As an emergency physician my greatest fear is that a patient would stay at home during an emergency because they worried about a bill,” said Dr. Tricia Anest, an advocate for the bill.

Anest said fellow doctors, hospital associations, and various patients have worked with lawmakers to craft a bill that would protect patients but also ensure adequate reimbursement to keep emergency rooms open and staffed.

Sally Matchett talks to a House subcommittee about the balanced billing proposal.
Sally Matchett talks to a House subcommittee about the balanced billing proposal.

Delegate Ware and Kathy Byron proposed similar bills to tackle balance billing.

One of the major differences though focused on the payment standard for services by doctors.

“Any bill that undermines a fair payment to physicians could undermine that safety net and leave Virginians without the best qualified physicians staffing their emergency rooms,” Anest said.

“That’s dealing with a fictitious figure of an average of commercial rates,” Delegate Byron contested.

Instead, Byron’s HB 2544 focuses on replacing one of three tests for determining the benefit the carrier is required to provide to an out of network provider of emergency services.

“The new test is the average of the contracted commercial rates paid by the health carrier for the same emergency service in the geographic region, which test replaces the amount negotiated with in-network providers for the emergency service, or if more than one amount is negotiated, the median of these amounts,” the bill states.

“We’ve been trying to come together with a reasonable solution but of course when it deals with money is difficult to do because people don’t want to let go too much,” Byron said.

"I'm hopeful,” Anest said. “I think we've really worked hard to find a solution that really is fair."

Ware’s bill would direct health insurance companies that provide any benefits for services given in an emergency department to pay directly to an out-of-network health care provider the “fair market value” for the emergency services, less applicable cost-sharing requirements.

"I'm so glad we've got the opportunity to work on this and hopefully push this through to get relief for everyone as well as myself because I'm in the pool with everyone else," Matchett said.

After Matchett’s story aired, hundreds of viewers reached out to NBC12 to share similar experiences.

According to Anest, she’s not surprised by the number of patients who have gotten a surprise bill.

“As emergency physicians we don’t check if somebody has insurance,” she said. “A large percentage of the care we provide is completely uncompensated. Most of us chose this because we like how anyone can come to us at any time and we can be there for them.”

"We're not looking at this as a bill that's great for doctors or great for insurance companies,” an advocate for Ware’s bill said. “It's something that provides that middle ground. We think the purpose here is to provide a bill that's great for patients."

Members of the committee did not vote on either bill Thursday. Instead, they suggested Ware and Byron to try and collaborate together to find a more uniform solution for the bills to move forward.

Each bill will be discussed at a future Commerce and Labor meeting.

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