State regulatory agency may tackle surprise medical bills

Deadline is approaching for you to weigh in
Updated: Aug. 7, 2019 at 3:44 PM EDT
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RICHMOND, Va. (WWBT) - A state regulatory agency may step in to stop the surprise billing of hospital patients, and time is running out for you to weigh in on this potential change.

It’s another pool day for Henrico County mom Sallie Smith. When this mom of three is not packing up the pool bag or making snacks, she’s working from home. Smith wasn’t prepared this summer for the shock she got when an unexpected email popped into her inbox.

“That’s when I clicked here. I was thinking ‘oh, this must be for a doctor visit’ or something that one of my children had. I haven’t been to the doctor in a long time,” said Smith.

The last time she went to the doctor was months ago on Jan. 3, to the Bon Secours stand-alone ER facility in Short Pump. She thought she had the stomach flu.

“I had been to patient first, I had talked to my regular doctor, but at this point I had not felt good for about a week,” she said.

She’s paid her co-pay and got a bill in the mail a month later from the doctor, which she also paid. Then six months later in June, she got a surprise in her email. A much bigger bill she had no idea was on the way.

“I thought at that point we were good. I was completely thrown off guard with that,” Smith said.

Her new bill was from the stand-alone ER facility, for $1,582. She owed $589 after insurance.

“For a visit that was less than 45 minutes,” added Smith.

If you count the doctor bill and her co-pay, it all totaled nearly $2,000.

Getting multiple bills from different entities is called surprise billing. Being asked to pay what insurance doesn’t cover is called balance billing. At least 25 states now have laws protecting patients from surprise bills. Virginia is not one of them.

However, a new rule being looked at by the State Corporation Commission would try to prevent the surprise. The SCC is considering requiring hospitals to tell all but emergency patients if providers involved in their care will bill separately for charges beyond what insurance pays.

“The bureau has experienced a growing number of complaints about balanced billing. What started as a handful of complaints has expanded to as many as 50 a year, but the bureau can only ensure that the insurance company has met its obligations under the term of the policy. That is almost always the case. The commission is currently taking comments on a proposed regulation prepared by the bureau that attempts to improve advance notice to a patient whenever there is a probably that services might be provided by an out-of-network provider,” spokesperson for the SCC, Ken Schrad, said.

Under the proposal, hospitals that fail to provide notice would be responsible for paying the balance of a patient’s bills.

“You wouldn’t go to a furniture store and just say I’ll take that bed and not know the cost and get a $2,000 bill in the mail,” said Smith.

While the change may not have affected her case because she went to a free standing ER she’s just glad it’s starting to be addressed in Virginia.

“There needs to be some kind of disclosure when you go into a facility like that. I think it’s very difficult for people who are an average American trying to work through the health insurance system in general."

The SCC is accepting comments on the proposed regulation until Aug. 9. Comments can be sent to the Clerk of the State Corporation Commission, Document Control Center, P.O. Box 2118, Richmond, VA 23219-2118, or submitted online. The case number is INS-2019-00081.

Public comments on this proposed regulation can be submitted until Aug. 9, using the SCC website.

If the SCC votes to begin this rule change, it would start on Oct. 1.

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