We previously blogged about the push by Washington’s Insurance Commissioner to ban so-called surprise medical billing, i.e., where an insured gets hit with a huge bill for medical treatment despite going to an in-network provider or seeking emergency care. In those circumstances, the insurer claims the hospital’s bill is too high and refuses to pay, and the hospital bills the patient for the difference. This practice (known as “balance billing”) results in the policyholder getting a huge hospital bill for medical care that was covered by their insurance policy, even if the policyholder used an in-network provider and did everything right. In these situations, the patient is stuck in the middle with the insurer and the hospital each blaming the other for the huge balance bill.
Washington’s surprise medical billing ban has now been signed into law by the Governor. The new law is touted as one of the strongest legal protections for health insurance policyholders and patients in the country.
Among other things, the surprise medical billing ban includes the following:
- Bans balance billing where you receive emergency medical treatment, even if it’s at an out-of-network facility – this includes seeking emergency medical treatment in a state bordering Washington State;
- Bans balance billing where you obtain treatment from an in-network provider, regardless of whether it’s an emergency;
- Requires insurers to pay out-of-network providers directly (as opposed to leaving the policyholder to fend for themselves.
One of the most significant reforms is that the new law requires insurers and medical providers to resolve billing disputes between themselves, rather than leaving the patient to deal with the excess bill from the provider. This is a huge win for policyholders and patients because it means patients are no longer left holding the bag when the insurer and doctor disagree over the medical bills. Insurers and hospitals have the resources to fight medical billing disputes and the bargaining power to keep them from happening in the first place – patients do not. The new law fixes a major injustice by preventing insurers and providers from imposing on patients the burden of resolving medical billing disputes.
Washington’s surprise medical billing reform is a big step forward for patients and health insurance policyholders.
Seattle Insurance and ERISA Blog 