A rule change could ease at least one health-care worry for Virginia families.
The State Corporation Commission is considering an insurance regulation that ultimately would provide important up-front information for patients.
The regulation would require health-care providers to warn patients in advance if a member of the medical team who would treat them happens not to be within their in-network insurance plan.
Out-of-network services can be significantly more expensive than in-network care. In-network services already have been negotiated between the provider and the insurance company to be offered to patients at a designated cost. Out-of-network services are not subject to this negotiated limit.
Therefore when a service is supplied by an out-of-network provider, but patients don’t know that they’re dealing with an out-of-network provider, severe sticker shock can ensue.
It’s called “balance billing” in medical insurance circles.
The SCC calls it “surprise billing.”
The proposed regulation that would fix it is somewhat convoluted, exerting its pressure through the state’s oversight of insurance rather than health-care providers directly.
It would apply to health-care plans managed by the state and would require companies to include a new provision in their contracts with hospitals or other medical facilities when they negotiate prices and other details.
In those contracts, providers would be required to alert patients if a member of their health-care team is an out-of-network provider. The information would have to be given far enough in advance that patients could make other arrangements for care if they didn’t want to pay (or couldn’t afford to pay) the higher out-of-network cost.
And if the provider failed to share that information, the provider would have to pay the difference between the in-network and out-of-network costs. Currently, the patient must pay — even if he didn’t know the higher costs were coming.
The suggested rule change addresses but one small aspect of today’s complicated, and often controversial, health-care/insurance system. But it does seek to alleviate one burden consumers face in trying to navigate that system — and that’s a good thing.
The SCC will hold a public hearing on the proposed change in Richmond on Sept. 12. The agency already has been collecting written comments on the proposed rule.
For more information, visit http://www.scc.virginia.gov/newsrel/i_insbil_19.aspx.