General Assembly agrees to compromise ending ‘surprise billing’

General Assembly negotiators reached a compromise to end the practice of “surprise billing.”

The practice arises when a consumer receives care from an out-of-network provider at an in-network hospital or healthcare facility.

SB 172, introduced by Sen. Barbara Favola, D-Arlington, and its House companion, HB 1251, introduced by Del. Luke Torian, D-Woodbridge, propose a model for ending “surprise billing” based on the one that has been successful in Washington state.

The bills provide that when a covered person receives covered emergency services from an out-of-network health care provider or receives out-of-network services at an in-network facility, the covered person is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement.

They also provide that the health carrier’s required payment to the out-of-network provider of the services is the usual and customary commercial payment.

“This is a major step forward for Virginians,” Favola said. “I am proud to be the chief patron of a bill that will protect patients from surprise medical bills. Virginians should be able to go to the emergency room or schedule a required surgery without worrying about a medical bill that is beyond their expected deductible or co-pay. It is time to protect consumers and make our healthcare system work in a rational and fair manner.”