Reports of Balance Billing Prompt Virginia General Assembly to Take Action

After hearing that balance billing is surprisingly common in their state, the Virginia General Assembly has turned its attention to the issue, proposing legislature to help protect patients from harmful medical billing practices.

A Virginia General Assembly health care panel recently heard reports that Virginians are being forced to cover an increasing amount of medical expenses due to balance billing. Balance billing occurs when a patient receives multiple bills from different doctors such as a pathologist, anesthesiologist, or radiologist because they are not covered by insurance. Patients are finding that, even when they go to an in-network hospital, the care they receive there may be considered out-of-network, or it may not be covered at all.

Anthem Blue Cross Blue Shield’s Program Director for Provider Solutions, Julie McGarrh, spoke to the General Assembly panel regarding the issue, according to a Daily Press report.

McGarrh reported that Anthem’s members were running into issues with balance billing, with one of them receiving a bill totaling $3,687 for urinalysis tests over the span of three months. Many of these tests should not be that expensive and are tests that anyone could “get done at Rite Aid for $50,” McGarrh said.

In response to this revelation, Del. Kathy Byron, the chair of the General Assembly’s Health Insurance Reform Commission, has said that the legislature will work to protect consumers from balance billing and its costs. Other members of the legislature voiced similar opinions after hearing about the balance billing.

“There’s no excuse for these kinds of charges for something somebody else is making money with at $50. Basically, it’s fraud,” said Sen. Frank Wagner.

Although the legislature now looking to help remedy the costs of balance billing, it will not be easy to change. Doug Gray, executive director of the Virginia Association of Health Plans, notes that many agreements between hospitals, doctors, and other providers are often to maximize profits. “If there are incentives to profit from balance billing, it will continue,” said Gray.

Many of the costs associated with balance billing occur in emergency situations. If a patient is brought into an out-of-network hospital in critical condition, and then required to undergo tests and potentially stay for observation, they likely have to pay the large bill after they are recovered.

Jill Hanken, director of the Virginia Poverty Law Center’s healthy communities program, urged the legislature to enact new laws which hold patients not accountable in emergency situations.

However, the situation is complicated. Byron has noted that the legislature needs to be cautious when proposing new consumer protections to avoid an increased cost in insurance for consumers. She has suggested that health providers should disclose if they are in-network or out-of-network for patients to avoid surprise charges from balance billing.

The issue is complex, and many consumers in Virginia and other states are currently struggling with the issue. These consumers need relief now and, although consumer protections will help, litigation against hospitals, providers, and other parties may help consumers recover the compensation they need. If you or a loved one received large charges from balance billing practices, you may be eligible to take legal action and recover compensation for surprise medical bills.

Join a Free Surprise Medical Bill Class Action Lawsuit Investigation

If you were hit with a surprise medical bill from an out-of-network doctor at an in-network hospital, you may be entitled to compensation.

Get a Free Case Evaluation Now