Resolution 18-110 

Submitted by: Richmond Academy of Medicine

WHEREAS,       it is becoming increasingly difficult for patients to protect themselves from surprise medical bills, and

WHEREAS,       patients are often not aware that specialists such as anesthesiologists, radiologist, ER physicians, etc. do not accept their insurance even though the hospital is in network, and

WHEREAS,       charges from out-of-network providers contribute to about a third of medical debt cases that non-elderly adults are struggling with, according to a survey conducted by the Kaiser Family Foundation and the New York Times, and

WHEREAS,       surprise coverage gaps are created by insurance carriers narrowing networks, a lack of transparency in pricing and costs, and a proliferation of high deductible plans that offer affordable premiums but often leave patients underinsured, and

WHEREAS        at the July, 2018 meeting of the Virginia Health Insurance Reform Commission, attendees were told by participating legislators to come up with a solution or the legislators would come up with their own and such solution(s) would likely not be favorable, therefore be it

RESOLVED,     that MSV work to mandate that, for a hospital/health system to be considered “in network”, that hospital/health system shall be required to employ or contract with a minimum of one in-network physician for all services offered, and be it further

RESOLVED,     that hospitals shall be required to be fully transparent with patients for non-emergent care about whether or not a provider of their service is in or out of network and that the patient be given a choice prior to care for an in or out of network provider.  If patient consent or an in-network provider is not available, the hospital/health system shall be responsible for payment of the care balance to the physician, and be it further

RESOLVED,     That a Payer network shall be considered “adequate” only if it contains 75% of providers within the hospital/health system’s geographic service area, and be it further

RESOLVED,     that the Payer maintain and publicize an accurate and current list of providers, and be it further

RESOLVED,     that network adequacy shall be determined by the Virginia Bureau of Insurance, a division of the Virginia State Corporation Commission.

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