Virginia lawmakers discuss balance-billing solutions

Members of the Virginia House of Delegate subcommittee on Commerce and Labor on Jan. 16 heard about how different bills would address balance billing, according to WWBT, an NBC-affiliated TV station in Richmond, Va.

Balance billing occurs when a patient is charged the remaining balance after the insurance company pays its part of the bill.

One bill, introduced by Delegate Lee Ware, addresses the issue in emergency situations. It requires that health carriers that provide individual or group insurance coverage that includes benefits for emergency services at a hospital  "pay directly to an out-of-network healthcare provider the fair market value for the emergency services, less applicable cost-sharing requirements." The out-of-network healthcare provider would be prohibited from billing or seeking payment from the patient except for the applicable cost-sharing requirements.

Delegate Kathy Byron has also proposed legislation. The bill she introduced is similar to Mr. Ware's, WWBT reported. But under Ms. Byron's bill, there would be a new test for determining the benefit the insurer is required to provide to an out-of-network emergency services provider.

"The new test is the average of the contracted commercial rates paid by the health carrier for the same emergency service in the geographic region, which test replaces the amount negotiated with in-network providers for the emergency service, or if more than one amount is negotiated, the median of these amounts," the bill states.

According to the report, members of the Virginia House of Delegate subcommittee on Commerce and Labor recommended that Mr. Ware and Ms. Byron work together on legislation. The bills are expected to come up again at a future subcommittee meeting.


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Rhode Island governor seeks to tax 'non-mission essential' hospital properties
Guide aims to help hospitals comply with accounting changes


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