Following intense debate, one piece of emergency-room balance-billing legislation makes it through crossover

By: - February 6, 2019 5:01 am

After hours of back-and-forth testimony in both House and Senate committees, in which lawmakers and lobbyists alike argued over four bills dealing with balance billing, only one clawed its way out of the chaos and passed a chamber on Tuesday.

The Senate unanimously passed legislation sponsored by Sen. Glen Sturtevant, R-Richmond, which would end the practice of balance billing — when a patient gets an unexpected bill because a doctor or other provider they thought was in their health plan’s network actually wasn’t covered.

Sturtevant’s was the only one aimed at emergency situations that survived. Each piece of legislation would do the same thing: take the patient out of the equation in cases of emergencies. But that seemed to be the only aspect of the problem everyone could agree on, as the hospitals and doctors’ groups were left arguing over who would take the bigger financial hit.

The bills sponsored by Sturtevant and Del. R. Lee Ware, R-Powhatan, were backed by provider groups. Under those bills, the doctors would be paid based on the average of similar payments in their region.

Sean Connaughton, president and CEO of the Virginia Hospital and Healthcare Association, said in a statement that the health care community sought a solution “that protects patients from being caught in the middle when health insurers refuse to pay legitimate claims arising from out-of-network emergency medical care.”

“In an emergency department, we can’t say we won’t see these patients, and because of that there’s no incentive for the insurance companies to negotiate,” said Dr. Todd Parker, an emergency physician with Riverside Health System who sits on the Virginia College of Emergency Physicians board.

But health plans pushed back, contending that those bills would mean the doctors are paid more and give them an incentive to leave the networks.

They supported two other bills, filed by Del. Kathy Byron, R-Bedford and Sen. Frank Wagner, R-Virginia Beach, which would have paid the doctors based on the average rate that the insurance company has already negotiated with other providers.

Lawmakers sided with the doctors, but Ware’s bill ended up in House Appropriations on Friday, and wasn’t added to the docket in time to reach the floor.

The Senate passed Sturtevant’s bill unanimously, but its future is not only dependent on action in the House, but on the budget as well. It has an amendment requiring that funding for the legislation be included in the budget bill.

According to the bill’s impact statement, it has an “indeterminate” financial impact, and it “could potentially have a substantial fiscal impact on the state employee health plan.”

Doug Gray, the executive director of the Virginia Association of Health Plans, argued that the amendment essentially means the bill isn’t going forward.

“The bottom line is that the providers asked for a payment that is higher than they would have received in network,” he said. “This would have caused the state to pay way more for their services, so clearly the bill is not ready to go at this point.”

Sen. John Cosgrove, R-Chesapeake, explained on the Senate floor that he and Sen. Lionell Spruill, D-Chesapeake, voted against sending the bill to the Senate Finance committee because they worried it would get that amendment.

“This is a good bill, our ‘no’ votes were directed to the sending of this bill to the dreaded Finance Committee,” Cosgrove said. “The clause is on the bill, so we anxiously await the final budget to see the language is in the budget so this bill can become law.”

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Katie O'Connor
Katie O'Connor

Katie, a Manassas native, has covered health care, commercial real estate, law, agriculture and tourism for the Richmond Times-Dispatch, Richmond BizSense and the Northern Virginia Daily. Last year, she was named an Association of Health Care Journalists Regional Health Journalism Fellow, a program to aid journalists in making national health stories local and using data in their reporting. She is a graduate of the College of William and Mary, where she was executive editor of The Flat Hat, the college paper, and editor-in-chief of The Gallery, the college’s literary magazine.