On behalf of the State Corporation Commission (Commission), the Bureau of Insurance (Bureau) submits this annual health insurance balance billing arbitration report. It summarizes information provided to the Bureau by arbitrators related to the resolution of balance billing disputes between health care providers and health carriers, as required by § 38.2-3445.02 I of the Code of Virginia (Code).

This report covers the period June 1, 2023, through May 15, 2024. During this time, the Bureau received 268 arbitrator decisions.(*1) Key highlights include the following:

• Of the total arbitration decisions rendered, 58% were decided in favor of the health carrier, and 42% were decided in favor of the provider.

• Health carriers prevailed in 71% of the decisions rendered in the emergency medicine specialty, while providers prevailed in 83% of the decisions rendered in the plastic or reconstructive surgery specialty and 86% of the decisions rendered in the anesthesiology specialty.

• The average amount awarded per claimant was $624 in emergency medicine, $1,898 in anesthesiology, and $16,147 in plastic and reconstructive surgery.

• Emergency medicine accounted for 75% of the arbitration decisions and plastic or reconstructive surgery for 16%. The anesthesia specialty made up 8% of the decisions, up from 0% in the prior reporting period.

• Decisions were rendered on behalf of seven provider practices. Among these seven, one group received 72% of the arbitration decisions. Seven carriers within six carrier groups were named in the decisions. Among these six, one group received 67% of the arbitration decisions.
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(*1) Appendix A contains information for each resolved arbitration during the reporting period.