SCC hearing on reg designed to protect against surprise medical bills


Virginia SCCThe State Corporation Commission will hold a hearing on Thursday, Sept. 12 to receive additional comments on a proposed regulation to protect Virginia consumers enrolled in managed care plans from receiving surprise medical bills.

The practice is known as balance billing. It occurs when patients receive bills directly from medical service providers who are not part of the managed care plan’s network of providers.

Since early June, the Commission has received dozens of written comments on the proposed regulation, including requests for a hearing. The hearing will be held at 10 a.m. in the Commission’s courtroom on the second floor of the Tyler Building, 1300 East Main Street in downtown Richmond. Any person wishing to speak about the proposed regulation is encouraged to arrive early and sign in with the Commission bailiff. The case number is INS-2019-00081.

As proposed, managed care health insurance plans regulated by the SCC’s Bureau of Insurance would be directed to include a provision in every contract with in-network facilities. The provision shall require any hospital or medical facility in the health plan’s network to give notice prior to admission or registration if the patient could be treated and billed by an out-of-network provider.

The notice must be sufficiently timely to allow patients to either decline the receipt of services from an out-of-network provider at the facility or contact the health plan to seek and change to another available in-network facility. As proposed, the option only applies to non-emergency services.

Under the proposed regulation, medical facilities that fail to provide this notice – not the patient – would be financially responsible for any costs from out-of-network providers that exceed the cost to the patient of in-network services.

View Order Scheduling Hearing


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