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Surprise Medical Billing Legislation Approved

June 4, 2019 • by Wiener & Lambka

The Washington legislature has approved a bill regulating “surprise medical billing”.

Drafted by the Insurance Commissioner of Washington, Michael Kriedler, this bill addresses the practice of health insurers denying payment for bills from providers who are not covered by the health plan but who have provided care for the insured while the insured was in a facility that was approved by the health insurance plan.

By way of example, a patient might go to an emergency room or an in-network hospital but some aspect of their care might be performed by someone who is not an employee of the hospital.  Examples include emergency room physicians, radiologists, anesthesiologists or lab technicians.

As things stand today, the patient may get a bill directly from one of these providers and have it denied or reduced by their insurance company, leaving the patient to pay the rest.  Because the providers are not contracted with the patient’s insurance company, they are not obliged to accept the reduction made by the health insurer and may bill the patient for the balance.

This bill is designed to establish a procedure to get the provider paid without unfairly leaving that responsibility solely to the patient, who had little choice in receiving care in this manner.  The bill has the insurance company and the provider work out their fees and payments and has them arbitrate any disputes, but the physician cannot bill the patient for the difference if they are not happy with the results.

The press release upon which this post is based can be found here.


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