Surprise Billing

Many of you may be aware that our state legislators have been contacted by numerous patients who recounted distressing experiences when they received unexpectedly high medical bills, not covered by their insurance. In many cases the patients had gone to their in-network hospital but were treated by out-of-network physicians. As a result, the state legislature is considering a number of proposals that would forbid any balance billing by physicians.

The important thing to understand is that some form of legislation will be passed. The legislators are more concerned, and outraged by, their constituents’ appeals than physicians’ arguments about fees or underinsurance. The Medical Society of Virginia has been working to come up with a proposal that will both address patient’s needs and limit the drop in reimbursement for medical services. Although the final proposal is still being debated, it will include a regional customary fee (available from usual insurance reimbursements), strengthen the prudent layperson standard, provide an appeal process through the Bureau of Insurance and require direct payment from the plans to the provider. The proposed legislation would apply to emergent conditions only. Despite its many shortcomings, the board of the VASPS voted to support the Medical Society’s proposal feeling that a strong show of support from all branches of medicine in the state would have a better chance to influence our legislators’ final decision. When the final document becomes available, we will distribute it.