Virginia Balance Billing Law

Overview

Virginia SB 1445 (2020) provides balance billing protections for emergency services and non-emergency out-of-network services at in-network facilities. This covers more scenarios than many states. The law includes baseball arbitration for dispute resolution. The Virginia State Corporation Commission handles complaints and enforcement.

Key Requirements

1. Emergency services at any facility are protected from balance bills under SB 1445.
2. Non-emergency OON services at in-network facilities are also protected under SB 1445.
3. Patients must receive written notice of balance billing rights.
4. Patients may request insurer review of charges within 30 days of the bill.
5. Baseball arbitration resolves disputes exceeding $1,000 when insurer and provider cannot agree.

Penalties and Enforcement

The Virginia State Corporation Commission enforces SB 1445 and federal NSA compliance. Violations result in fines and enforcement actions. Providers who balance bill for protected services face penalties. Consumers can file complaints with VA SCC. Baseball arbitration provides binding resolution for high-value disputes.

Appeals and Exceptions

Balance billing protections apply to emergencies and non-emergency OON at in-network facilities under SB 1445. Elective out-of-network care at out-of-network facilities is not protected. Federal NSA standards provide supplemental coverage for emergency services.

Interaction with Federal Law

Virginia SB 1445 provides broader protections than federal NSA in some areas. SB 1445 covers non-emergency OON at in-network facilities; NSA covers emergencies and some non-emergency scenarios. VA SCC coordinates with CMS on compliance. When federal and state law conflict, the more protective standard applies.

Common Questions