Lawmakers are urgently trying to solve a problem that puts patients in the middle of billing nightmare when they least expect it. Consumer Reporter Susan Hogan explains.
Patients who assume if a hospital accepts your insurance, the doctors you see there do as well could be making a costly mistake.
If you go to an emergency room where you know your insurance is good, there’s a possibility the doctor you is out of your network and bills you for whatever the insurance doesn’t cover.
“They can charge whatever they want, and no one is telling them they can't, so the individual is stuck paying the bill,” said Virginia Del. Kathy Byron (R-22nd District).
It’s called surprise balance billing.
“Hospitals aren't in a position when a patient comes into an emergency room setting to inquire about who their insurance carrier is because the frontline staff at the hospital is focused on their primary job, which is addressing the immediate medical needs of that patient,” said Julian Walker of Virginia Hospital and Healthcare Association.
Twenty-one states have laws protecting patients from surprise balance billing, but Virginia isn't one of them.
Virginia's health plans, hospitals and physicians all agree, in an emergency situation, patients should not be balance billed, but they can’t agree on how to make that happen.
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“When we're in network with the hospital, we think that the providers in that hospital should have to be in network, too, and that's a simple requirement,” said Doug Gray of the Virginia Association of Health Plans.
“Doctors ultimately want to get in network,” said Ralston King of Medical Society of Virginia. “They want to be in network with the Aetnas, the Uniteds, the Anthems. Often times they're just unable to negotiate a fair rate they believe should be paid.”
Lawmakers say hospitals have an even greater responsibility to their patients to be transparent.
“Where else do you go where you walk in and are not aware at a minimum of what you're going to pay for something when you leave?” Byron asked. “I don't know too many instances that I can think of where that situation happens.”
Byron said she plans on proposing legislation when the session begins in January. All parties assured they will reach a solution together.
