Resolution 18-109 

Submitted by: Virginia College of Emergency Physicians

WHEREAS,     the Medical Society of Virginia policy 10.5.04- Balance Billing, which states “The Medical Society of Virginia supports physician’s ability to accept assignment of benefits and to balance bill patients that have coverage through a managed care organization with whom the physician does not have a contractual relationship” needs to be amended, therefore be it

RESOLVED,     that the Medical Society of Virginia amend policy 10.5.04 by substitution as follows:

The Medical Society of Virginia believes that when a patient receives emergency services from an out-of-network physician, the insurer should hold the patient harmless for the cost of the health care services provided, with the exception of the patient’s co-pay, co-insurance, or deductible. An appropriately determined reimbursement should be paid directly and in a timely manner to the physician by the health insurer.

The Medical Society supports policies that will reduce a patient’s risk of receiving a surprise bill. This includes ensuring all emergency services are reimbursed as emergency services, based on the prudent layperson standard; establishing stronger network adequacy requirements; requiring all health plans to contract with any willing provider; and requiring physicians, hospitals and health insurers to provide as much notification as possible for scheduled health care services when a provider is out-of-network.

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