On behalf of the State Corporation Commission (Commission), the Bureau of Insurance (Bureau) has prepared this annual report summarizing the health insurance balance billing dispute resolution information it received from arbitrators as it relates to disputes between health care providers and health insurance carriers, as required by § 38.2-3445.02 I of the Code of Virginia (Code). This report covers the period June 1, 2022, through May 31, 2023.

The Bureau received 246 arbitrator decisions.(*1) Key highlights include the following:

• Of the arbitration decisions rendered:

o 63.8%, or 157, were decided in favor of the health carrier, and

o 36.2%, or 89, were decided in favor of the provider.

• Sixty-nine percent of the decisions rendered in the emergency medicine specialty were decided in favor of health carriers, while fifty-eight percent of the decisions rendered in the plastic and reconstructive surgery specialty were decided in favor of providers.

• The average amount awarded per claimant by specialty area was $571 in emergency medicine and $14,457 for plastic and reconstructive surgery.

• 80.5% of the decisions involved emergency medicine, and 19.5% involved plastic and reconstructive surgery. None involved the anesthesia specialty, down from 36.8% in the prior reporting period.

• Decisions were rendered on behalf of seven provider practices. Eight carriers within five carrier groups were named in the decisions.

_________________________________________________
(*1) Appendix A contains information for each resolved arbitration during the reporting period.