Balance billing occurs when a patient receives a bill because an insurance company doesn’t cover its full share and the patient is billed the difference. This “difference” happens because sometimes patients may be cared for by an “out of network” doctor.

Doctors may be out of network because:

  • Insurance companies limit the number of doctors allowed to join;
  • The plan’s reimbursement is significantly lower in comparison to others, which jeopardizes a doctor’s ability to provide quality care

Emergency Services

In an emergency, it is unsafe and illegal for a doctor to ask a patient about insurance. Physicians’ ultimate priority is providing their patients with the immediate care they need.

Ancillary Services

Sometimes a patient needs diagnostic, laboratory, or pathology services that cannot be provided by their regular doctor. Their regular doctor may send out a specimen for additional testing; these services are “ancillary services.” Because of insurance participation changes, the treating physician may not know if the ancillary service provider is in or out of the patient’s insurance network.

MSV’s Position on Balance Billing

The Medical Society supports changes to reduce or eliminate surprise balance billing. For surprise billing to end, it is critical for lawmakers to work with patients and the groups that understand patients’ health best. Physicians’ ultimate priority is providing their patients with the care they need, at the time that they need it. 

Resources

Virginia hospitals oppose plan to stop some surprise medical bills - September 13, 2019

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