Virginia protects patients from surprise medical bills when they get care from an out-of-network doctor at an in-network facility during emergencies and some non-emergencies. The law creates a process between health care providers and health insurers to resolve the billing issue, removing patients from the dispute.
Making Health Care Work for You
Virginia hospitals have led the charge on passing consumer-friendly health care reform laws to empower people and families in making informed health care decisions.
Among the patient-focused reforms are laws and policies that protect patients from surprise medical bills, allow patients to ask for good faith price estimates from hospitals prior to scheduled procedures, require group health plans and health insurers to disclose cost-sharing information and publicly provide information on negotiated payment rates, place limits on aggressive medical debt collection, and require hospitals to post health care item and service prices online.
Many people don’t know these laws exists. We want to change that so patients and families can take control of their health care.
This site offers educational resources and links to support and empower people in making personal medical decisions.
Know Your Rights as a Patient
Protecting Patients from Surprise Bills
Year passed: 2020
Health Insurance Transparency
A federal regulation requires group health plans and health insurance issuers to disclose cost-sharing information to members and to post files online containing all negotiated payment rates.
Year passed: 2021
Health Care Price Transparency
Hospitals are required to post price information about medical items and services online for the public to see and even comparison shop if they choose. To make things easy, VHHA has created a listing of links to this price information for hospitals across Virginia.
Year passed: 2022
Good Faith Price Estimates
Virginians can ask for a good faith price estimate from a hospital at least three days in advance of a scheduled test or procedure.
Year passed: 2016
Financial Assistance and Medical Debt Collection
Hospitals are required to post information about charity care policies, advise uninsured patients about financial assistance policies and payment plan options, report annually on the amount of charity care and financial assistance provided, and limits are placed on hospitals’ ability to aggressively collect medical debts.
Year passed: 2022
Who Determines Hospital Price Transparency Compliance?
Federal hospital price transparency rules took effect in 2021. Several independent organizations have done assessments of compliance with a wide range of conclusions on compliance rates. The fact is that the Centers for Medicare & Medicaid Services (CMS) is the only true judge of compliance.
How does health insurance contribute to the rising costs of health care?
A study by the non-partisan Altarum Institute found that from 2008-2021 “single annual premiums have increased 74.3%, and family premiums have increased 78.9%” and the “combined totals of average premiums and deductibles have risen even faster, 89.1% for single coverage and 91.3% for family coverage” in Virginia.
What Are the Insurance Price Transparency Standards?
Under a federal regulation finalized in 2021, group health plans and health insurance issuers are required to disclose cost-sharing information to members and to post files online containing all negotiated payment rates. Health plans are also required to have online price comparison tools for their members. The tools must let health plan members receive out of pocket cost estimates for 500 common procedures.