HAMPTON, Va. (WAVY) — You get treatment at a hospital that’s in your health plan’s network, but then you get an additional bill from an out-of-network provider.
It’s called surprise billing, and it happens because your in-network hospital has certain specialists that are out of network.
We’ve documented several local cases where the patient ended up with a bill for several thousand dollars they thought was covered.
Alan Balch, CEO of the National Patient Advocate Foundation headquartered in Hampton, says even though ending surprise medical bills is supported on both sides of the aisle, the issue is stalled because of the money that’s at stake.
“Our official position is that we want patients to be held harmless,” Balch said in a Wednesday phone interview.
“There’s a reason why those groups that end up charging the surprise bills are out of network. They won’t negotiate at the in-network rate.”
In May we reported on the STOP Surprise Medical Bills Act, which would take the patient out of the equation – and require the medical provider and the health care plan to settle the difference in the rates.
While that federal legislation is stalled right now on Capitol Hill, Balch says some states have come up with a hybrid solution to surprise billing. It combines setting rates for various procedures with a process of arbitration that would be similar to the process used by Major League Baseball.
“The physicians and the physicians groups are generally pro-arbitration, and part of their rationale is they don’t want the government setting rates, period,” Balch said.
Balch has advice for patients in the meantime: keep a close eye on your bills — and don’t be afraid to call your provider or insurance plan and get them to explain.
“If you have expensive out-of-pocket costs on your bill, those bills are often too complicated to try to discern yourself, so don’t be afraid to call and ask for help.”
Balch says nine bills went to the most recent General Assembly regarding surprise billing in Virginia.
Governor Ralph Northam’s office formed a working group that includes providers, health plans, hospitals and Balch’s own National Patient Advocate Foundation. Their task will be to come up workable legislation on surprise billing for the next General Assembly.
The Medical Society of Virginia’s position on surprise billing