George Barker voted Yea (Replaced by Substitute ) on this Legislation.
Title: Authorizes Enrollee not to Pay Out-of-Network Amount Except Applicable Cost-sharing Requirement
Signed by Governor Ralph Northam
Title: Authorizes Enrollee not to Pay Out-of-Network Amount Except Applicable Cost-sharing Requirement
Title: Authorizes Enrollee not to Pay Out-of-Network Amount Except Applicable Cost-sharing Requirement
A vote to pass a substitute bill that authorizes enrollee not to pay out-of-network amount except applicable cost-sharing requirement.
Prohibits an out-of-network provider to bill an enrollee for (Sec 1):
Emergency services provided to an enrollee; or
Non-emergency services provided to an enrollee at an in-network facility if the non-emergency services involved surgical or ancillary services provided by an out-of-network provider.
Specifies that an enrollee satisfies their payment obligation if they pay the in-network cost-sharing requirement in their health plan contract (Sec 1).
Requires the health carrier and out-of-network provider to ensure that the enrollee incurs no greater cost than the median in-network contracted rate for the same or similar services in the geographic area (Sec 1).
Specifies that the carrier shall provide an explanation of benefits to the enrollee and the out-of-network provider that reflects the cost-sharing requirement (Sec. 1).
Specifies that the amount paid to an out-of-network provider for health care services shall be a commercially reasonable amount, based on payments for the same or similar services provided in a similar geographic area (Sec. 1).
Specifies that the parties may reach an agreement on reimbursement during this time and before the arbitration proceeding and specifies that (Sec. 1):
The parties shall be permitted to bundle claims for arbitration; and
Within 7 calendar days of receipt of notification from the initiating party, the Commission shall provide the parties with a list of approved arbitrators or entities that provide arbitrations.
Establishes that the Commission shall contract with the nonprofit data services organization to establish a data set and business process to provide health carriers, health care providers, and arbitrators with data to assist in determining commercially reasonable payments and resolving payment disputes for out-of-network medical services rendered by health care providers (Sec. 1).
Specifies that the Commission, in consultation with health carriers, health care providers, and consumers, shall develop standard template language for a notice of consumer rights notifying consumers of the following (Sec. 1):
The prohibition against balance billing is applicable to health benefit plans issued by health carriers in Virginia and self-funded group health plans; and
Consumers cannot be billed for the balance of their health care services.
Title: Authorizes Enrollee not to Pay Out-of-Network Amount Except Applicable Cost-sharing Requirement
Title: Authorizes Enrollee not to Pay Out-of-Network Amount Except Applicable Cost-sharing Requirement