Some of that comes from a practice known as balance billing, when an out-of-network provider bills the patient for whatever their insurance company won’t pay. Those range from prohibiting health systems from balance billing to requiring insurers to hold their members harmless, which means the patient isn’t liable for the charges. And during this year’s session, a bill Byron introduced to address balance billing for ancillary services was continued to next year. The Health Insurance Reform Commission heard from representatives from Virginia’s hospitals and health plans about balance billing in a roundtable discussion, during which each pointed fingers at the other. But Dr. Trisha Anest, an emergency room physician with Bon Secours Mary Immaculate Hospital, said that she doesn’t know her patient’s insurance status because it is irrelevant.