First surprise medical bills head to arbitration under Virginia’s new balance-billing ban

VCU Emergency hospital entrance in Richmond.
VCU Emergency hospital entrance in Richmond.(Parker Michels-Boyce / For The Virginia Mercury)
Published: Jul. 16, 2021 at 3:01 PM EDT
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Doctors and hospitals are up 2-1 over insurance companies as the first three disputes resolved under the state’s ban on balance billing emerge from arbitration, according to a report released this month by state regulators.

The new approach, which went into effect Jan. 1, removes patients from fights between providers and insurers over unexpected medical bills.

In a typical case, someone might find themselves seeking treatment at an in-network hospital only to later learn that the facility contracted with an out-of-network doctor, who billed them for thousands of dollars that their insurance company wouldn’t cover.

Under legislation the General Assembly passed last year, patients will no longer receive those bills as long as they’re covered by a state-regulated health plan. Instead, when providers and insurance companies can’t agree on a fair payment, the case heads to arbitration and the two parties work it out amongst themselves.

In the first five months of the year, the State Corporation Commission’s Bureau of Insurance says it received 120 arbitration requests, accepted 102 and resolved three.

In the case won by an unnamed insurance company, a patient was billed $3,262 for anesthesia at an outpatient surgery center. The plan ultimately offered to pay $549 of the tab, while the anesthesiologist offered to lower the bill to $1,310.


.(Virginia Mercury)

The Virginia Mercury is a new, nonpartisan, nonprofit news organization covering Virginia government and policy.

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