Health insurance; payment to out-of-network providers. (SB1763)

Introduced By

Sen. Glen Sturtevant (R-Midlothian) with support from co-patrons Sen. Amanda Chase (R-Midlothian), and Sen. Bill DeSteph (R-Virginia Beach)


Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law


Balance billing; emergency and elective services. Directs health carriers that provide individual or group health insurance that provide any benefits with respect to services rendered in an emergency department of a hospital to pay directly to an out-of-network health care provider an amount, less applicable cost-sharing requirements, that is equal to the greatest of (i) the amount negotiated with in-network providers for the emergency service or, if more than one amount is negotiated, the median of these amounts; (ii) the regional average for commercial payments for emergency services as of the date of treatment; (iii) the amount that would be paid under Medicare for an emergency service; and (iv) if out-of-network services are provided (a) by a health care professional, the regional average for commercial payments for such service, or (b) by a facility, the fair market value for such services. The bill removes from the determination of whether a medical condition is an emergency medical condition the final diagnosis rendered to the covered person. The bill requires a facility where a covered person receives scheduled elective services to post the required notice or inform the covered person of the required notice at the time of pre-admission or pre-registration. The bill also requires such a facility to inform the covered person or his legal representative of the names of all provider groups providing health care services at the facility, that consultation with the covered person's managed care plan is recommended to determine if the provider groups providing health care services at the facility are in-network providers, and that the covered person may be financially responsible for health care services performed by a provider that is not an in-network provider, in addition to any cost-sharing requirements. The measure includes an enactment providing that it shall not become effective unless an appropriation that addresses the anticipated effects of this act on the general fund is included in a general appropriation act passed in 2019 by the General Assembly that becomes law. Read the Bill »


Bill Has Failed


01/18/2019Presented and ordered printed 19104632D
01/18/2019Referred to Committee on Commerce and Labor
01/30/2019Impact statement from DPB (SB1763)
01/31/2019Reported from Commerce and Labor with substitute (13-Y 2-N) (see vote tally)
01/31/2019Committee substitute printed 19106123D-S1
01/31/2019Incorporates SB1228 (Chase)
01/31/2019Incorporates SB1354 (McDougle)
01/31/2019Incorporates SB1360 (Wagner)
01/31/2019Rereferred to Finance
02/01/2019Reported from Finance with amendment (16-Y 0-N) (see vote tally)
02/04/2019Constitutional reading dispensed (40-Y 0-N) (see vote tally)
02/05/2019Read second time
02/05/2019Reading of substitute waived
02/05/2019Committee substitute agreed to 19106123D-S1
02/05/2019Reading of amendment waived
02/05/2019Committee amendment agreed to
02/05/2019Engrossed by Senate - committee substitute with amendment SB1763ES1
02/05/2019Printed as engrossed 19106123D-ES1
02/05/2019Constitutional reading dispensed (39-Y 0-N) (see vote tally)
02/05/2019Passed Senate (40-Y 0-N) (see vote tally)
02/08/2019Placed on Calendar
02/08/2019Read first time
02/08/2019Referred to Committee on Appropriations
02/19/2019Left in Appropriations