Balance Billing Update - September 17, 2018

Lauren Schmitt
VSA Lobbyist
Commonwealth Strategy Group

VOS continues to work with the Medical Society of Virginia and other physician specialty groups to explore potential policy options to address balance billing. In August, the Health Insurance Reform Commission (HIRC) made it clear that balance billing and its impact on patients is a serious issue in Virginia. The legislators on the HIRC directed the relevant stakeholders to come up with a solution or the General Assembly would provide its own solution. As a result, we have had several meetings with our physician colleagues, hospitals and representatives from the health plans.

The provider community has met twice with the health plans to discuss potential solutions and determine if there is any common ground. It appears that all the parties agree that there should be notification to a patient when non-emergent services may be out-of-network. We are working to determine what that notification entails and what the consequences are when a patient is not given proper notice. The biggest area of contention right now is how to handle situations when a hospital is in-network, but the physicians providing emergency services in the hospital are out-of-network. The HIRC has expressed the most concern over this scenario – mainly because the patient has no choice in the matter when they are seeking emergency care. The physician community wants to hold patients financially harmless in this scenario, but still preserve the ability to negotiate a fair and reasonable rate with health plans. We are currently exploring an option that would define usual and customary rates as the regional average of payments for emergency services.

VOS’s lobbyists recently met with Senator Ryan McDougle, who is on the Health Insurance Reform Commission and is the Chair of the Senate Republican Caucus. He was very clear that it is illogical that a hospital would be “in-network” but the physicians working there would be “out-of-network.” He believes the easiest solution is to require hospitals to only contract with or employ physicians who accept the same health plans as the hospital. Senator McDougle indicated that he’s willing to consider other ideas, but so far he has not heard anything that would be as effective or simple as this requirement. He acknowledged that this type of requirement could unfairly tip the scales in negotiations, but that is not his concern. Senator McDougle, like his colleagues on the HIRC, are primarily focused on how to protect the patients from a surprise/balance bill. This meeting reiterates that the physician community is not in a position to prevent an adverse outcome at the General Assembly, but rather in a position where we must do what we can to minimize the adverse outcome.

We will continue to keep you updated with potential policy proposals and developments in our stakeholder discussions.