Balance billing; emergency and elective services. (SB522)

Introduced By

Sen. Ryan McDougle (R-Mechanicsville)


Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law


Balance billing; emergency and elective services. Requires health care facilities and health care providers to determine if providers scheduled to deliver elective services to a covered person are in the network of the covered person's managed care plan. The measure requires that when an elective service provider is determined to be out-of-network, in order for the covered person to assume financial responsibility for the out-of-network provider's charges, the health care facility or provider shall (i) inform the covered person of the out-of-network status of the provider, (ii) provide the covered person with the opportunity to be referred to an in-network provider, and (iii) prepare a document for signature by the covered person in which the covered person or his legal representative assumes financial responsibility for services performed by the out-of-network provider, and the covered person must sign the document described in clause (iii). The bill provides that such requirements will also apply to a health care provider in an office-based setting making a referral for elective radiology or pathology services. The bill identifies post-stabilization services, performed in order to maintain or improve a person's stabilized condition related to an emergency medical condition, as emergency services if (a) the post-stabilization services are preapproved or related to preapproved services; (b) for an out-of-network facility, the health carrier does not effectuate transfer of the covered person within a reasonable amount of time after being notified by the facility of the covered person's need for post-stabilization services; (c) for an out-of-network health care professional, the facility is in-network; or (d) the out-of-network facility is unable to reasonably obtain health carrier information from the covered person prior to the furnishing of such services. The measure 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 the fair market value, as defined in the bill, for the emergency services, less applicable cost-sharing requirements. The bill provides that direct payment from the health carrier to the out-of-network health care provider precludes the out-of-network health care provider from billing or seeking payment from the covered person for any other amount other than the applicable cost-sharing requirements. The bill removes from the determination of whether a medical condition is an emergency medical condition the final diagnosis rendered to the covered person. This bill was incorporated into SB 172. Read the Bill »


02/09/2020: Incorporated into Another Bill


01/07/2020Prefiled and ordered printed; offered 01/08/20 20102243D
01/07/2020Referred to Committee on Commerce and Labor
01/15/2020Assigned C&L sub: Health Insurance
02/05/2020Impact statement from DPB (SB522)
02/09/2020Incorporated by Commerce and Labor (SB172-Favola) (14-Y 0-N) (see vote tally)

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