MedicaidAdministrativeHigh impact
What You Need to Know About Balance Billing
Aetna Better Health of Virginia·VA·Reimbursement
We identified it
Aug 13, 2026
Summary
Aetna Better Health of Virginia has reinforced its balance billing prohibition for all covered services. Participating providers are contractually prohibited from billing members beyond their cost-sharing liability and may only bill for non-covered services with prior written informed consent. Providers who violate this policy face network termination, Medicaid fraud investigation referral, and potential HHS-OIG referral.
Action Required
Immediately: Billing team must implement the following controls: (1) Review all current billing practices to ensure no balance billing occurs for Aetna Better Health of Virginia covered services beyond member cost-sharing liability; (2) Update billing software validation rules to flag and prevent balance billing attempts for this plan; (3) Train all billing and front-desk staff that balance billing Aetna Better Health members is prohibited and carries severe penalties including network termination; (4) Establish a process to review remittance advice cost-sharing amounts and ensure member statements only reflect those amounts; (5) Create a procedure for handling member balance billing complaints with immediate escalation to Provider Relations at 1-800-279-1878 (TTY: 711). For any non-covered services, require providers to obtain written informed consent from members BEFORE treatment. Failure to comply will result in network termination, referral to Virginia Medicaid Fraud Division, and potential HHS-OIG investigation.