American Society of Plastic Surgeons
For Consumers

Virginia | Washington: Out-of-Network Debate

ASPS has been working closely with the state plastic surgery societies and key stakeholders on the ground to address out-of-network proposals impacting the specialty in both Virginia and Washington.

In Washington, ASPS has been actively engaged with the Washington Society of Plastic Surgeons (WSPS) and Washington State Medical Association (WSMA) on recently introduced measures to address balance billing. The Society has concerns regarding a measure that favors insurance carriers over providers in billing disputes. As such, ASPS signed on to a coalition letter led by the WSMA encouraging continued negotiations on the bill and a request that the committee considers three amendments to eliminate bias towards the insurance carriers. Additionally, ASPS and WSPS submitted co-signed comments to the Washington House Appropriations Committee in advance of the committee's hearing on the bill with recommended changes, including: strengthening patient notifications; ensuring fair and timely payment; removing arbitration; and prohibiting ERISA plans from opting-in due to legal concerns. The measure was heard in the Appropriations Committee on February 20, but did not receive any action.

ASPS also worked with the Virginia Society of Plastic Surgeons (VASPS) to support fast-moving out-of-network legislation. Since 2018, VASPS has been working closely with the house of medicine in good faith negotiations with the health plans on this issue, as instructed by the state legislature. The house of medicine was optimistic that it would be able to strike a deal that protected patients from balance billing for emergency room care while still allowing physicians to negotiation fair reimbursement with the health plans. Unfortunately, the carriers were unwilling to meet the group half way and negotiations fell apart.

VASPS, the Medical Society of Virginia, other physician specialties and the hospitals worked with Delegate Ware and Senator Sturtevant in introducing legislation that would: requires health plans to pay providers a fair and reasonable reimbursement; ban balance billing in the emergency department; require health plans to pay providers directly; and ensure care is covered regardless of the final diagnosis. The health plans introduced their own measure that would expressly ban balance billing in the emergency department and set out-of-network reimbursement at the average in-network rate. The carriers' bill was successfully defeated in committee while the VASPS measure advanced their committee. ASPS submitted comments to the House Committee on Appropriations in support of the bill. Unfortunately, the bill failed to receive a hearing in committee before the end of the very short, seven-week legislative session.