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 received from 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 May 15, 2024, through May 15, 2025. During this time, the Bureau received 252 arbitrator decisions.(*1)

Key highlights include the following:

• Of the total arbitration decisions rendered, 55% were decided in favor of the health carrier, and 45% were decided in favor of the provider.

• Health carriers prevailed in 68% of the decisions rendered in the emergency medicine specialty, while providers prevailed in 66% of the decisions rendered in the plastic or reconstructive surgery specialty, 95% in the anesthesiology specialty, and 64% in the neurology specialty.

• The average amount awarded per claimant by specialty was $439 in emergency medicine; $1,185 in anesthesiology; $11,882 in plastic and reconstructive surgery; and $6,624 in neurology.

• The emergency medicine specialty accounted for 69% of the arbitration decisions and plastic or reconstructive surgery for 18%. The anesthesia specialty made up 8%, and neurology 6%.

• Decisions were rendered on behalf of nine provider practices. Among these nine, one group received 68% of the arbitration decisions. Nine carriers within six carrier groups were named in the decisions. Among these six, one group received 70% of the arbitration decisions.
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(*1) Appendix A contains information for each arbitration decision received during the reporting period.