Start your free consultation

New Virginia Balance Billing Protection Law

Posted on 02/02/21 by admin in Personal Injury

The BIG news in Virginia since January 2021 has been the new Virginia balance billing protection law. This new law protects consumers from large unexpected hospital bills. Large hospital bills most often come from an emergency room visit. Insurance companies did not cover emergency room bills under old laws in Virginia. Thus the ‘surprise billing’. 

New Virginia Balance Billing Protection Law

The Virginia balance billing protection law benefits the injured, rather than the insurance company. Insurance companies receive the large medical bills. Nonetheless, under old laws, they often refused to pay providers for health care services rendered. Patients have to pay these unexpected bills. These circumstances left many confused and upset. Under the Virginia balance billing protection law, patients will no longer be responsible for unexpected medical expenses once they have met their obligations. Obligations such as meeting the deductible or co-payments. There should be no extra steps for the patient. Insurance companies need to work with the hospital if they are ‘out-of-network’ medical specialist.

Insurance doesn’t cover costs of all healthcare providers. Regardless, a hospital or facility will still send the costs to your insurer. They may deliberate back and forth on how to cover the costs if the insurance company doesn’t agree on the amount. However, you will not have to negotiate this issue because the Virginia balance billing protection law states that the insurance company and health care provider need to figure this out. However, not everyone is automatically covered under these new protections.

Employers having a self-funded insurance plan are not automatically opted in this protection plan. In this case, someone would need to purchase or enroll in the protection coverage manually. To know for sure if you are protected under the Virginia balance billing protection law, ask your employer or your insurance company. The new Virginia law also covers many different types of medical services.

What Does Virginia Balance Billing Protection Law cover?

There should be no more unexpected costs from a healthcare provider. Even after certain medical procedures. Procedures such as but not limited to: 

  • Surgery
  • Anesthesia
  • Pathology
  • Radiology
  • Hospitalist services

Receiving medical treatment doesn’t have to be a complicated decision now. Virginia consumers can now get medical help without having to worry about an expensive bill. 

The balance billing law does not protect everyone however. The new law applies for all Virginia-regulated managed care plans, plans bought through ‘’ or with state employee health benefit plans. All protection laws will be listed, so that no one is left wondering, “do I qualify”? Negotiation starts if there is a disagreement between your insurance company and the hospital on a bill.

Disagreeing On The High Bill Amount: Insurance VS Medical Provider

This new bill is mainly to protect consumers. Therefore, you, as the patient will not have to get involved if a high bill is charged. The insurance company will have 30 days to refund any amount above your in-network cost-sharing requirement. Needless to say, it’s on the insurance company to figure out a price with the healthcare providers. Any disagreement leads to negotiation or a ‘clean claim’.

Negotiation or arbitration may come after a disagreement between the healthcare provider and insurance company. Arbitration is a problem resolution tactic using an arbitrator to settle a dispute outside of court. In these cases, there has to be an agreement. Insurers may be subject to fines or other sanctions by the Virginia State Corporation Commission if they don’t try to cooperate. So far it sounds like the insurance company has to compromise a lot, however there are laws in place so that medical specialists can’t freely agree on what they want. If healthcare providers routinely violate this law without trying to fix the issue, they will be subject to fines or other measures by the Virginia Board of Medicine or the Virginia Commissioner of Health as well. Whatever happens in this process, you should no longer have to deal with a large medical bill under this law in Virginia.

Keep this new law in mind if you decide to handle a personal injury case on your own. Moreover, if you hire a Virginia lawyer, they should know these new laws and protect you from dealing with work that a case involves. 

Billing Discussion With a Virginia Personal Injury Lawyer

Hiring a Virginia injury lawyer may save you from the headache of remembering and researching if you are eligible under the Virginia Balance Billing Protection Law. Moreover, some personal injury law firms offer a contingency fee system. Under a contingency fee system, medical bills would be covered until the final settlement. You wouldn’t even have to worry about unexpected insurance company bills and have to wait for a refund. Give us a call if you’re still unsure: (202) 933-1918. However you decide to handle your Virginia claim, know that patients may be protected from high emergency room bills under this new law.