Effective Jan. 1, 2020, certain medical providers are prohibited from sending surprise bills to consumers in Washington state under a new law that Insurance Commissioner Mike Kreidler championed.
Patients in Washington who receive emergency services or certain services at an in-network hospital or surgical facility cannot be surprise or ‘balance’ billed from an out-of-network provider.
“For more than a decade, we’ve heard from many people hit with a balance or surprise medical bill,” said Kreidler. “They shared their stories of receiving a bill on top of what they expected to pay, despite going to their health plan’s hospital or facility. Just within the last year we learned of two consumers who received surprise bills of over $100,000 and who both faced losing their homes and medical bankruptcy.”
Washington is just one of 13 states to approve comprehensive protections against surprise bills. Its law is considered among the strongest in the nation.
“I think the breadth of these stories – and that no one was immune – finally provided the motivation needed for the parties to come together and work out a solution. I’m grateful to the many consumers who told their personal stories.”
The new law also allows self-insured employers to opt in to the protections for their employees. To date, over 150 such employers have opted in to the new law.
Key protections include:
- A consumer who receives emergency care in an out-of-network emergency room or who receives a non-emergency medical procedure in an in-network hospital or facility cannot be balanced billed.
- An insurer cannot balance bill a patient if they seek emergency care at an out-of-network facility in a state that borders Washington.
- Insurers must pay the out-of-network provider or facility directly for care their enrollee receives.
- If the insurer and provider or facility do not agree on a commercially reasonable payment for out-of-network services within 30 days, their dispute goes to binding arbitration.
- Consumers will be given a notice describing when they can and cannot receive a balance bill.
- Insurers, providers and facilities must include up-to-date network information on their websites.
- Any provider who continues to illegally balance bill may be referred to the state Department of Health for enforcement.
“There is much more that we need to do to address the challenges facing our health care system,” said Kreidler. “But to finally put this issue to rest lifts a weight for many and should give thousands of consumers more piece of mind. For now, we’ll settle for that victory.”