Washington State Senate *unanimously* passes tough bill cracking down on #SurpriseBilling!

This Just In from the Washington State Insurance Commissioner's office...

Kreidler's bill to protect consumers from surprise billing passes Senate
April 10, 2019

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler’s proposal to end the harmful practice of surprise medical billing passed the Senate today on a vote of 47 to 0. It now goes back to the House of Representatives for a concurrence vote before heading to the governor’s desk.

Second Substitute House Bill 1065 (www.leg.wa.gov) prevents consumers from getting a surprise bill when they seek either emergency treatment at an out-of-network emergency room or medical services at an in-network hospital or facility but are treated by an out-of-network provider.

“I’ve heard from hundreds of people with health insurance who received a surprise medical bill on top of what they expected to pay,” said Kreidler. “We learned this year of two Washington families facing surprise medical bills of $100,000 and $227,000. Both feared bankruptcy and losing their homes. Something is clearly wrong with our system when you have health insurance, follow what’s required by your health plan, and you still face medical bankruptcy.”

Kreidler added, “Thankfully, everyone involved this year worked really hard on bill language that everyone can live with – and most importantly, that protects consumers from being caught in the middle. 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."

In part, under the proposed legislation:

  • 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 to describe when a consumer can and cannot be balanced billed.
  • Insurers, providers, and facilities must include provider network information on their websites.
  • Any provider who continues to illegally balance bill may be referred to the state Department of Health for enforcement.

“We are close to enacting one of the strongest surprise billing laws in the country,” said Kreidler. “It strikes a good balance and does what everyone agrees should happen – it takes the innocent consumer out of the middle of these billing disputes.”

Amidst the slugfest over the ACA, Medicare for All and so forth, there seems to be basically two areas of potential for genuine bipartisan progress to be made re. healthcare policy: Surprise/balance billing and prescription drug prices.

Of course, the odds are that the rule about insurers having to pay the out-of-network provider/facility directly will mostly lead to overall premiums being nudged upwards to absorb the cost, and I could see lots of potential for hospitals/doctors to start playing games with the rates they charge (especially the ones just outside the WA border), but at least this cuts the enrollee/patient themselves out of the loop.