Surprise Billing Arbitration: It's Working!
In 2021, a law went into effect in Virginia that ended surprise "balance bills" for patients who saw a healthcare provider or visited a facility that was outside of their insurance plan's network.
VACEP's Surprise Billing FAQ page is our most-visited website page and offers more insight on the law. Go there now.
Instead, the law states, insurers must pay providers and facilities a "commercially reasonable amount," or, if that amount isn't agreed upon by the two sides, an arbitration process is available.
Emergency physicians account for the vast majority of these arbitrations (nearly 81%), and this month, the State Corporation Commission released a report with insight into how that process is going. In short: They're down, and that's good.
The Richmond Times-Dispatch covered the news. The full article requires a subscription. Here are some of the report's takeaways:
The average amount awarded per emergency medicine claimant was $571
“My best read is that the system is working the way it was supposed to," the Medical Society of Virginia's Clark Barrineau told the Times-Dispatch
From May to June, 36% of rulings were in favor of providers, down from 37% a year prior
Arbitrations from emergency medicine fell from 432 to 198
VACEP government affairs lead Aimee Perron Seibert said the decline in arbitrations shows that medical practices and insurers are finding a middle ground about what providers should be paid — which was the ultimate goal
