Balance Billing Laws in Virginia
Your medical billing rights and protections in Virginia.
Virginia enacted the Surprise Medical Billing Protection Act (HB 1251/SB 172, 2020) and additional strengthening legislation. The law prohibits balance billing for emergency services and for non-emergency services at in-network facilities when patients have no meaningful choice of provider. Virginia also enacted SB 1357 (2021) further strengthening protections, effective January 1, 2022.
Key Protections in Virginia
Emergency services: Balance billing prohibited for emergency care; patients pay only their in-network cost-sharing amounts
Non-emergency care at in-network facilities: Protected from balance billing when patient had no meaningful choice of out-of-network provider
Dispute resolution: Virginia Bureau of Insurance administers a state dispute resolution process
Disclosure: Out-of-network providers must give at least 10 days' notice and written cost estimates before non-emergency services
Filing Information
Within 2 years of the date of service for Virginia state complaints
Additional Notes
Virginia's Surprise Medical Billing Protection Act applies to state-regulated health plans. Self-funded ERISA plans fall under the federal No Surprises Act. Consumers can call the Bureau of Insurance toll-free at 1-877-310-6560.
How to File a Complaint in Virginia
Gather Your Documentation
Collect your itemized medical bill, Explanation of Benefits (EOB) from your insurer, any prior authorization documents, and written communications with the provider or insurance company.
File with the State Regulator
Submit your complaint to the Virginia Bureau of Insurance (State Corporation Commission). Include all supporting documents and a clear description of the billing dispute.
File complaint with Virginia Bureau of Insurance (State Corporation Commission)File with CMS if Federal Protections Apply
If your dispute involves the No Surprises Act (emergency care or out-of-network providers at in-network facilities), you can also file directly with the Centers for Medicare & Medicaid Services.
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