Virginia Billing Rights
Additional State-Law Protections for Patients with State-Regulated Health Plans
- Insurers are required to tell you which providers and facilities are in their networks. Providers and facilities must tell you with which provider networks they participate. This information is on the insurer’s, provider’s or facility’s website or on request.
- When you get services from an in-network facility, certain providers there may be out-of- network. In these cases, the most those providers can bill you is your plan’s in-network cost- sharing amount. This applies to emergency medicine, laboratory, surgeon and assistant surgeon services, and professional ancillary services such as anesthesia, pathology, radiology, neonatology, hospitalist, or intensivist services. These providers can’t balance bill you and can’t ask you to give up your protections not to be balance billed.
- Consumers covered under (i) a fully-insured policy issued in Virginia, (ii) the Virginia state employee health benefit plan; or (iii) a self-funded group that opted-in to the Virginia protections are also protected from balance billing under Virginia law.
- Virginia’s balance billing restrictions for “emergency services” also includes the following as related to any mental health services or substance abuse services (as defined under state law) rendered at a behavioral health crisis service provider:
- a behavioral health assessment that is within the capability of a behavioral health crisis service provider, including ancillary services routinely available to evaluate such emergency medical condition, and
- further examination and treatment, within the capabilities of the staff and facilities available at the behavioral health crisis service provider, as required so that the patient’s condition does not deteriorate.
Filing a Complaint
If you think you’ve been wrongly billed, You may file a complaint with the federal government through the U.S. Department of Health and Human Services at www.cms.gov/nosurprises/consumers or by calling 800-985-3059 and/or file a complaint with the Virginia State Corporation Commission Bureau of Insurance at: scc.virginia.gov/pages/File-Complaint-Consumers or call 877-310-6560.
State Agency Contact Information
Virginia State Corporation Commission Bureau of Insurance
Phone: 800-985-3059
Website: scc.virginia.gov/pages/Balance-Billing-Protection
Additional Information
Visit scc.virginia.gov/pages/balance-billing-protection for more information about your rights under Virginia law.
Visit www.cms.gov/nosurprises/consumers or call 800-985-3059 for more information about your rights under federal law.