Health insurance; definitions, payment to out-of-network providers, emergency services. (SB172)

Introduced By

Sen. Barbara Favola (D-Arlington) with support from co-patrons Sen. Jennifer Boysko (D-Herndon), Sen. Siobhan Dunnavant (R-Henrico), Sen. John Edwards (D-Roanoke), and Sen. Jennifer McClellan (D-Richmond)


Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law


Health insurance; payment to out-of-network providers. Provides that when a covered person receives covered emergency services from an out-of-network health care provider or receives out-of-network services at an in-network facility, the covered person is not required to pay the out-of-network provider any amount other than the applicable cost-sharing requirement. The measure also provides that the health carrier's required payment to the out-of-network provider of the services is the usual and customary commercial payment. If such provider determines that the amount to be paid by the health carrier is not appropriate, the measure requires the provider and the health carrier to make a good faith effort to reach a resolution on the appropriate amount of the reimbursement and, if a resolution is not reached, authorizes either party to request to enter arbitration. The measure requires the State Corporation Commission to establish rules for an expedited arbitration process to settle disputes between providers and health carriers arising out of such disputes. Under the measure, the Commission is required to establish a portal on its website for the submission of arbitration claims, (ii) contract with independent arbitrators to settle such disputes, (iii) ensure the arbitrators do not have a conflict of interest with the parties and have experience in health care billing, and (iv) maintain a list of such arbitrators on its website. The measure provides certain factors that an arbitrator is required to consider when settling such a disputed claim. The measure provides that provisions of the bill do not apply to an entity that provides or administers self-insured or self-funded plans; however, such entities may elect to be subject such provisions. The measure requires health carriers to make reports to the Bureau of Insurance and directs the Bureau to provide reports to certain committees of the General Assembly. Read the Bill »


02/18/2020: In Committee


12/20/2019Prefiled and ordered printed; offered 01/08/20 20101733D
12/20/2019Referred to Committee on Commerce and Labor
01/15/2020Assigned C&L sub: Health Insurance
01/16/2020Impact statement from DPB (SB172)
01/31/2020Impact statement from DPB (SB172)
02/09/2020Reported from Commerce and Labor with substitute (8-Y 7-N) (see vote tally)
02/09/2020Committee substitute printed 20107408D-S1
02/09/2020Rereferred to Finance and Appropriations
02/10/2020Reported from Finance and Appropriations with amendments (11-Y 5-N) (see vote tally)
02/11/2020Read second time
02/11/2020Reading of substitute waived
02/11/2020Committee substitute agreed to 20107408D-S1
02/11/2020Reading of amendments waived
02/11/2020Committee amendments agreed to
02/11/2020Engrossed by Senate - committee substitute with amendments SB172ES1
02/11/2020Printed as engrossed 20107408D-ES1
02/11/2020Constitutional reading dispensed (40-Y 0-N) (see vote tally)
02/11/2020Passed Senate (36-Y 4-N) (see vote tally)
02/14/2020Placed on Calendar
02/14/2020Read first time
02/14/2020Referred to Committee on Labor and Commerce
02/18/2020Referred from Labor and Commerce
02/18/2020Referred to Committee on Appropriations
02/20/2020Impact statement from DPB (SB172ES1)

Duplicate Bills

The following bills are identical to this one: HB1251 and HB1494.

Post a Public Comment About this Bill

if you have one

(Limited HTML is OK: <a>, <em>, <strong>, <s>)