Lawmakers vowed to do something about ER balance billing this session. They didn’t.

By: - February 21, 2019 5:10 am

During a series of meetings last year, lawmakers gave passionate speeches decrying the practice of balance billing.

They called it an unfair, serious problem that could land someone in medical debt and ruin their credit, even if they have health insurance. Several lawmakers issued a warning to  feuding lobbyists representing health insurers, hospitals and doctors: If they didn’t come up with a solution themselves, then legislators would.

But they didn’t.

Several bills were filed this session that would prohibit emergency room balance billing — when a patient goes to an in-network hospital but is assigned a doctor who is out-of-network, usually without the patient’s knowledge. He or she then gets a bill from the provider for the amount that the insurance company wouldn’t cover.

It’s a national problem that has gotten widespread attention as more people raise concerns about rising health care costs.

At the beginning of this session, the Virginia General Assembly seemed poised to end the practice. But the bickering that prevented lobbyists from reaching a consensus spilled into the legislature, and though some less controversial legislation to end the practice around elective services succeeded, all the bills that would have ended emergency room balance billing died.

“What I hear is, ‘You’ve got to do something to reduce my health care costs,'” said Sen. Frank Wagner, R-Virginia Beach, who submitted one of the bills that health insurers supported. “It’s the number one issue. They pay us to come up here and analyze the situation and understand what’s going on and try to bend that curve.

“This was one method we could do to help protect the people we represent so we start to deal with the number one issue on my voters’ minds. And we dropped the ball.”

Legislation sponsored by Sen. Glen Sturtevant, R-Richmond, that doctors’ groups supported made it furthest, passing the Senate unanimously. But then it landed in the House Appropriations Committee and wasn’t placed on the docket. The same fate befell a similar House bill, sponsored by Del. R. Lee Ware, R-Powhatan.

“This is, I think, a story that tells a lot about the influence of various interest groups in Virginia government and the legislature,” Sturtevant said.

He lamented the fact that, without any successful legislation, Virginians will be susceptible to balance billing for another year — as did Jill Hanken, a health care attorney with the Virginia Poverty Law Center.

“Consumers will have yet another year to be hurt by the practice of balance billing,” she said. “It’s very much a consumer beware situation. Anytime people go to hospitals or even see their doctors they need to ask questions of the doctors and of their insurance plans to see whether or not the people actually giving the services are in network. But the burden should not be on consumers.”

Various health care groups said the lack of successful balance billing legislation is unfortunate and disappointing. They also continued to point fingers at each other, with providers suggesting that insurers were responsible for the bill’s ultimate downfall.

“Unfortunately, in order to protect record profits, the health insurance industry blocked attempts to pass a reasonable solution, despite overwhelming, bipartisan support from legislators,” Dr. Bruce Lo, president of the Virginia College of Emergency Physicians, said in a statement. “Ultimately, insurance industry profits prevailed over patients.”

Unsurprisingly, health insurers blamed providers.

“The suggestion that we are profiting unreasonably from ER visits and that’s the reason this bill died is preposterous,” countered Doug Gray, executive director of the Virginia Association of Health Plans. “The people who are seeking profits unfairly from emergency room patients are doctors and hospitals and they’ve been doing it for 20 years. Every balance billing example is from an ER doc and from a hospital. The best way for them to stop balance billing is to stop doing it. Period.”

Wagner said he thinks more public awareness would help legislation get across the finish line in the future. If there was a stronger movement behind ending balance billing, he argued, the legislation would have had a better chance because more lawmakers would share his passion for ending the practice.

But because few people know about it until they’re victims of the practice themselves, it doesn’t get as much attention as it deserves.

“Where’s the outrage?” he said. “If they knew, they’d be outraged.”

Sturtevant and Wagner both referenced the power of lobbyist groups in explaining why none of the bills passed, Sturtevant pointing at the insurance lobby and Wagner at the hospital and doctor lobby.

But they both also acknowledge that lawmakers are ultimately responsible for cutting through the arguments and coming up with a solution.

“That’s the job of legislators, that’s why we are here, it’s to be able to see those issues that affect lots of individuals who don’t have their own interest group or lobby organization, that’s our job to represent them down here,” Sturtevant said. “Sadly, because one committee is able to refuse to hear a bill, we can’t find a solution.”

Both vowed to continue to pursue the issue, and Sturtevant said he plans to campaign on it before the November elections.

“There are a lot of issues in the General Assembly where it takes two, three, four sometimes more sessions to actually get the ball across the goal line and get it signed into law,” he said.

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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.