Washington State Enacts Law Limiting Balance Billing

A new law has gone into effect in Washington that will prevent healthcare organizations from sending surprise medical bills to individuals who receive emergency care or other services at hospitals or facilities where they have insurance coverage.

Surprise billing occurs when a patient receives treatment from a physician who is not part of the patient’s insurance network even though the doctor may be working at a facility that is part of the insurance network. The charges from the out-of-network doctor are generally not covered by insurance and can lead to the patient receiving a “surprise” bill when he or she leaves the hospital. In many surprise billing cases, the patient is at the hospital to be treated for an emergency and is not capable of checking whether all the physicians at the facility are part of his or her insurance network. This situation is also sometimes referred to as “balance” billing.

A recent study found that doctors who are more likely to surprise bill — such as an anesthesiologist or emergency room doctor — charge more when the patient does not have the required health insurance. About one out of every six emergency room visits leads to an individual receiving a surprise medical bill for out-of-network coverage, according to a study released earlier this year by the Kaiser Family Foundation. As well, 67% of individuals are worried about being able to afford paying a surprise medical bill, according to the study.

Washington is now one of 13 states that have addressed this growing problem. The bill, “Protecting consumers from charges for out-of-network health care services,” can not be balance billed when receiving emergency care in an out-of-network emergency room or when receiving a non-emergency medical procedure in an in-network hospital or facility. As well, patients who receive emergency care at an out-of-network facility in a state that borders Washington can not be balanced billed, either.

“There is much more that we need to do to address the challenges facing our health care system,” said state Insurance Commissioner Mike 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.”

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