The Virginia General Assembly is determined to prevent surprise balance billing. In anticipation of the 2019 session, the Health Insurance Reform Commission (HIRC) convened a work group to examine the issue. Legislators were clear - physicians must develop a patient-friendly solution or Virginia would prohibit balanced billing completely.

MSV is fighting for a fair solution for patients and doctors. SB 1763 introduced by Sen. Sturtevant and HB 1714 introduced by Del. Lee Ware would address emergency balanced billing. The bills would protect patients from balanced billing and ensure physicians are paid a directly. In addition, the bills would pay providers a fair and reasonable amount.

2019 General Assembly Update

MSV is working with the entire physician, patient, and hospital community to advocate for patient-friendly solutions that also secure reasonable and sustainable reimbursements. The health plans have blocked our efforts to protect patients in this legislation. We are down to one bill- SB 1763 (Sturtevant). SB 1763 passed the Senate unanimously and has been referred to the House Appropriations Committee.

SB 1763 Proposes Pro-Patient Reforms - MSV, physician specialty societies, and VHHA are in support of SB 1763.

  1. Abolish balanced billing for emergency medical services. Balanced billing, or “surprise” billing, is when an out-of-network medical provider bills a patient for costs that are not paid by their insurance company.
  2. Ensure providers are paid directly by insurers. This takes the patient out of the middle – they don’t have to worry about cashing an insurance check and paying a large bill. The insurer will pay the provider directly.
  3. End insurance denials for emergency care based on a final diagnosis. Currently, insurance companies may decline to pay the full cost of an emergency visit if they determine that the final diagnosis does not warrant the level of tests and care provided. This bill would end that practice.

Pro-Patient House Bill

HB 1714 (Ware) was the House version of this bill and successfully reported out of House Commerce and Labor Committee. The bill was sent to the House Committee on Appropriations due to Anthem raising speculative financial concerns about the state employee health plan. Anthem applied substantial pressure of future risk which resulted in the Appropriations Committee not hearing the bill.

House of Medicine Wins

  • HB 2544 (Byron) Emergency balance billing bill, which would have given insurance companies unilateral authority to establish rates with no transparency, ultimately limiting patient access to emergency care, died this week in House Commerce and Labor Committee.
  • HB 2543 (Byron) ancillary services balance billing bill was struck by the patron this week. This bill would have applied onerous requirements on the referring and treating physicians before the patient could receive treatment or services.  


Emergency Balance Billing Leave Behind

Lawmakers Hear Bills to Protect Patients from Balanced Billing - January 17, 2019

Virginia Lawmakers Seek Solution for Surprise Balance Billing - September 20, 2018

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