Insurance Commissioner: Washington now has strongest law in the country to protect against surprise billing for emergency care

Insurance Commissioner Mike Kreidler

On May 21, 2019 Gov. Jay Inslee signed Insurance Commissioner Mike Kreidler’s request legislation to end surprise medical billing, enacting arguably the strongest law in the country to protect consumers from this unfair practice.

The new law (www.leg.wa.gov) protects consumers from getting a surprise bill when they get either emergency services at an out-of-network emergency room or medical treatment at an in-network hospital or facility but are seen by an out-of-network provider.

“For more than a decade, we’ve heard from people hit with a balance or surprise bill,” said Kreidler. 

“They’ve shared their stories of receiving a bill on top of what they expected to pay, despite going to the hospital or facility their health plan covers. Many wanted to know how this could be legal. 

"This year, we learned of two consumers who received surprise bills of over $100,000 and who both faced losing their homes and medical bankruptcy.”

Kreidler added, “I think the breadth of these stories – and that no one was immune – finally provided the motivation needed for the sides to come together and find a solution.

"I’m grateful to Rep. Eileen Cody, D-West Seattle, and Sens. Christine Rolfes, D-Kitsap County, and Annette Cleveland, D-Vancouver, for their critical work on this legislation and to the other legislators who supported this important consumer protection."

The new law takes effect starting Jan. 1, 2020. Key protections include:

• A consumer who receives emergency care in an out-of-network emergency room or who has 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.
• A disclosure template will be developed and must be given to patients 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.

Kreidler’s office will develop rules this summer for the new law. Sign up to get updates.

“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.”