COVID-19 Procedures: All business with the Commission should be through electronic filing systems, email, or by telephone. For public health safety, in-person visits to SCC offices are suspended. Filings or other deliveries are permitted by drop off at main entrance. On-site staff is minimal and processing of such deliveries may be delayed.
Balance Billing Protection
Virginia’s new balance billing law and rules, effective January 1, 2021, protects consumers from getting billed by an out-of-network health care provider for emergency services at a hospital or for certain non-emergency services during a scheduled procedure at an in-network hospital or other health care facility. The law covers emergency services, laboratory services, and any professional non-emergency services, including:
- Hospitalist services
What should I do if I get a surprise medical bill?Effective Jan. 1, 2021, you cannot be balance billed or surprise billed for certain services.
- Contact the provider or facility and tell them you believe you've been wrongly billed. Request that your bill be lowered.
- After contacting the medical provider, you can also contact your insurance company for assistance.
- Reference your policy or member ID card for your insurance company's contact information or use our License Lookup to find their contact information.
- If you are still unsatisfied after contacting the medical provider and your insurance company, you can also file a complaint with our office and we will review your case.
- If the medical provider and your insurer are unable to agree on an acceptable payment, the provider and the insurer can then enter arbitration.
- Arbitration will only affect what you will pay if you are covered by a catastrophic or high deductible health plan with a Health Savings Account (HSA) and have not reached your full deductible amount.
Does the law apply to my health plan?The balance billing law applies to:
- all Virginia-regulated managed care plans
- plans bought through HealthCare.gov
- state employee health benefit plans
List of Elective Group Health Plans Opted-In to Balance Billing
If your plan is not on the list, you should check your plan documents or contact your health plan for information on whether this law applies to your health plan.
How much must I pay for a surprise medical bill?
- You are not responsible for paying a surprise medical bill if the protections apply. Your insurer must pay the out-of-network provider and facility directly.
- You are only responsible to pay for what you would normally pay for the same service from an in-network provider, including any copays, coinsurance and deductible.
What health insurers must do
- Base your financial responsibility on what you would pay an in-network provider or in-network facility in your area and show the amount on your Explanation of Benefits (EOB).
- Exception: if you have a high deductible health plan with a Health Savings Account (HSA) or a catastrophic health plan, you may need to pay additional costs, but you still will not be responsible for more than your cost share.
- Include any amount you pay for emergency services or certain out-of-network services at an in-network facility toward your in-network deductible and out-of-pocket limit.
- Provide the names of providers, hospitals, and facilities that are in-network.
- Provide notice to you of your rights (in English, Spanish, Korean, or Vietnamese) under the balance billing law and let you know when you can and cannot be balance billed.
What medical providers and facilities must do
- Tell you which provider networks they participate in.
- Refund any amount you overpay within 30 business days.
- Provide notice to you of your rights (in English, Spanish, Korean, or Vietnamese) under the balance billing law to let you know when you can and cannot be balance billed.
- Not ask you to limit or give up these rights.