Justices to review ‘balance billing’

The Supreme Court of Virginia has agreed to review a case focusing on whether a hospital can bill a patient the full amount of its charges when the hospital is “out-of-network” for the patient.

A Henry County judge last year forced a hospi­tal to accept 25 cents on the dollar for a patient’s emergency room care after hearing testimony that the hospital would normally accept 25 per­cent if a patient arranged for pre-payment.

The patient, a banker who suffered apparent heart symptoms, had signed a contract presented to him at the Martinsville hospital. Judge David V. Williams ruled the contract lacked mutual as­sent, comparing the situation to a “Your money or your life” proposition.

The hospital contends Williams erred in con­cluding the patient’s signature did not establish mutual assent. The patient did not qualify for the discounts offered to “prompt-pay patients,” the hospital also says in its assignments of error.

Williams’ decision is a rare judicial rejection of hospitals’ so-called “balance billing,” the practice of accepting payment from an insurance compa­ny and then billing the patient at full price for the unpaid balance. The situation arises when the patient’s insurer does not have a contract with the hospital for reduced rates.

Patients often do not know whether providers are in their network when they get care.

A Kaiser Family Foundation study found that charges from out-of-network providers were a common factor for insured, non-elderly adults struggling to pay medical bills.

The Supreme Court agreed to consider Wil­liams’ ruling on Nov. 1.