Balance Billing Protection Updates in 2022

In January 2021, a Virginia balance billing law was passed to protect fully insured health plan members from receiving an unexpected balance bill from an out-of-network provider for emergency services and for some non-emergency services administered by out-of-network providers at in-network facilities.

Changes Under the Federal No Surprises Act

Effective on the first day of a health plan’s 2022 coverage or plan year, health insurance plans offered through group coverage or through the individual market will include federal balance billing protections through the No Surprises Act. This applies to all fully insured and self-funded groups. Some differences from the Virginia rule include:

  • Covered services have been extended to include post-stabilization and air ambulance services.
  • Cost sharing is calculated differently (members will still be responsible for in-network cost sharing).
  • The provider and health plan payment dispute process (independent dispute resolution, or IDR) is slightly different when federal rules apply.

Visit our balance billing page for details on potential federal administration costs.

Existing Virginia Balance Billing Rules

The existing Virginia balance billing rules remain in effect for all groups. These protections will be coordinated with federal protections depending on the type and place of service.

If you have any questions, please view our balance billing page or contact your Optima Health representative.