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Virginia House & Senate Vote Against Surprise Hospital Bills

Virginia House & Senate Vote Against Surprise Hospital Bills

Earlier this month, both the Virginia House and Senate unanimously passed identical legislation to stop issuing surprise hospital bills for some Virginians. The legislation will go into effect on January 1, 2021.

Surprise bills, also known as “balance billing,” are issued to patients who seek emergency care at either an out-of-network hospital or receive treatment from an out-of-network doctor at a facility included in their network.

The major problem with balance billing is that patients may not even realize that they are receiving treatment from an out-of-network provider. Thus, the large medical bills come as an unwelcome “surprise.”

According to an article in Virginia Lawyers Weekly, a teenager was billed $34,000 after a plastic surgeon outside of his network treated his broken nose. The treatment occurred at a hospital included in his family’s insurance plan.

The article also references studies that suggest surprise billing occurs in as many as 20% to 42% of emergency room visits statewide.

The bill was modeled after a law passed in Washington state which states that patients who receive out-of-network emergency care must be charged the in-network rate mandated by their plan. This includes their standard copay and deductible.

Insurers are the ones responsible for compensating any out-of-network providers a “commercially reasonable” rate. However, if the medical professional or facility that offered the treatment disagrees with that rate, they have 30 days to reach an agreement with the insurer. If an agreement cannot be reached, both sides can make their cases to an arbitrator who will decide the final amount. In Virginia, the arbitrator is not required to be an attorney.

The new law only applies to Virginia patients with state-regulated health care plans. Those who hold Employee Retirement Income Security Act (ERISA) plans must opt into the law for it to apply.

If you have any questions about the new law and how it may affect you, feel free to reach out to our firm. The Law Offices of Ryan Quinn, PLLC has been assisting clients with medical malpractice issues for years and our attorney is familiar with Virginia law and local practices.

Have you or a loved one been hurt by a medical professional or while in the care of a hospital or clinic? You may have a case. Contact us today to speak with our Arlington medical malpractice attorney.


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