The State Corporation Commission on Thursday began taking comments about a new rule that would strip the surprise out of balance billing.
The proposed regulation would require hospitals to tell all but emergency patients if providers involved in their care will bill separately for charges beyond what their insurance pays.
The rule is intended to prevent the surprise of balance billing that occurs when, unknown to a patient, an out-of-network radiologist reads a scan or when a patient carefully selects an in-network surgeon and hospital only to find out later that her anesthesiologist does not have a contract with her health plan.
The SCC, following lawmakers’ directions, is addressing only non-emergency hospital care. Lawmakers agreed to amend state law to require prior notice. They failed, however, to address emergency-room balance billing, which has been occurring with some LewisGale Medical Center patients.
Last year, LewisGale contracted with Schumacher Clinical Partners to provide emergency room physicians and hospitalists. Schumacher has negotiated with Anthem for hospitalists, but emergency room doctors are not in Anthem’s and other insurers’ networks.
Schumacher says it will accept whatever insurers pay, and patients who are billed otherwise should use a special email account, firstname.lastname@example.org, to challenge the charges.
The SCC said when patients enter hospitals or medical facilities that are in their health-plan networks, they assume that they will be charged co-pays, coinsurance and deductibles, and that hospitals will accept the amounts in their contracts with insurers.
The proposed regulation is anticipated to take effect Oct. 1. It does not halt balance billing, just the surprise element in which patients discover afterward that they are obligated to pay hundreds or thousands of dollars in unanticipated charges. Hospitals would be required to tell patients about out-of-network providers before they are admitted so that they could decide whether to go elsewhere for care.
Hospitals that fail to provide notice would be responsible for paying the balance on patients’ bills.
The SCC is accepting comments until Aug. 9. Comments can be sent to the Clerk of the State Corporation Commission, Document Control Center, P.O. Box 2118, Richmond, VA 23219-2118, or submitted online through www.scc.virginia.gov/case/PublicComments.aspx. The case number is INS-2019-00081.