Virginia's surprise-billing enforcement could 'pit facilities and providers against one another,' physicians say

Virginia hospitals and physicians are speaking out against a state regulatory agency's proposed rules to enforce surprise-billing legislation, according to The Roanoke Times.

The State Corporation Commission Bureau of Insurance have been working on rules to enforce a Virginia bill passed by lawmakers earlier this year.

The bill aims to ensure patients are aware of potential out-of-network charges prior to elective procedures. Under the bill, hospitals are required to consult insurance companies and notify patients if an out-of-network professional will be involved in their elective procedure and if the patient could be on the hook for the difference between what the insurer pays and what the provider charges, according to the Times. The practice is known as balance billing. Virginia's law addresses balance billing with elective procedures and not emergency care.

One State Corporation Commission Bureau of Insurance proposed rule to enforce the law would require hospitals to notify patients is an out-of-network provider could be involved in their care, and would leave hospitals responsible for the balance after insurer payment if they don't offer the notice, the Times reported.

But hospitals are expressing concerns about the proposed rule. According to the Times, hospitals said it is the Virginia Department of Health and the Department of Medical Assistance Services that has authority to regulate healthcare providers, and that the State Corporation Commission Bureau of Insurance is "attempt[ing] to indirectly regulate a third party that has the least control over the decision of whether a facility-based provider is in-network or out-of-network."

Physicians also expressed concerns. The newspaper reported that the Medical Society of Virginia said that the State Corporation Commission Bureau of Insurance's proposed rules "pick winners and losers, pit facilities and providers against one another, and ultimately regulate everyone except health plans."

Insurers are more positive about the proposed rules, although Lindsay Winter of Anthem Blue Cross and Blue Shield said that payers are limited in terms of enforcing contract language requiring healthcare facilities to use of in-network providers, according to the Times.

The State Corporation Commission Bureau of Insurance has been accepting public comments and will hold a hearing Sept. 12.


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