It took weeks of negotiations to settle on an end to balance billing, a much-loathed feature of Virginia’s medical system that’s been locked in a legislative deadlock for years.
Lawmakers were jubilant on Thursday as both the House and Senate unanimously passed identical legislation to remove the risk of surprise hospital bills for some Virginians. The often-expensive fees often come when patients seek emergency care at an out-of-network hospital, or receive treatment from out-of-network doctors at a facility that’s otherwise covered by their insurance.
In many cases, patients don’t know they’re receiving treatment from an out-of-network provider. In one case, a Northern Virginia teenager was billed $34,000 after an out-of-network plastic surgeon treated his broken nose at a hospital included on his family’s insurance plan.
Doctors and hospitals have been pitted against insurance companies on the issue for years. Neither side thinks patients should receive surprise medical bills, but they’ve been unable to reach a resolution on how — and how much — doctors should be paid for treating an out-of-network patient.
Frustrated, a team of legislators pushed a bill that leaves the decision to a third party if providers and insurers can’t reach an agreement.
“When an individual needs medical care, that person needs to feel confident they can access that care without going bankrupt,” said Sen. Barbara Favola, D-Arlington, who carried the legislation in the Senate. “This has been a long time coming.”
The final version of the legislation borrows a model that was first adopted in Washington state. Under the new law, patients who receive out-of-network emergency care — or treatment from an out-of-network doctor at a hospital covered by their plan — can only be charged the in-network rate required by their plan, including their usual copay or deductible.
The Virginia Mercury is a new, nonpartisan, nonprofit news organization covering Virginia government and policy.