Insurance Commissioner Mike Kreidler is proposing legislation (HB 1065/SB 5031) for the fourth consecutive year to protect consumers from receiving a surprise medical bill.
More than 230 Washingtonians have shared their personal surprise billing stories with him over the last three years. This includes a Vancouver-area resident who received charges of $112,000 after seeking medical attention for her son during an emergency.
“Imagine how you’d feel if after doing everything we asked you to do – get insurance, make sure you go to an in-network hospital – you get an unexpected bill on top of what you expect to pay,” Kreidler said.
A hearing on Kreidler’s proposed legislation is scheduled for Jan. 23 in the House Health Care and Wellness Committee.
Surprise billing happens when you go to an in-network hospital or ambulatory surgical facility for a covered service but are treated by a medical provider who is not contracted with your insurance company. Because no contract exists between your insurance company and the provider, the provider is allowed to bill you the difference between what the insurer pays and what doctors believe the service is worth.
This can unexpectedly add hundreds to thousands of dollars to a bill beyond what an insurance plan will cover.
Kreidler’s proposal would prevent an out-of-network provider from sending a consumer a surprise bill for a covered service at an in-network hospital or ambulatory surgical facility. The provider and insurers must work out their payment issue. If they cannot agree, they go to binding arbitration and are forbidden from billing the consumer.
Currently, 11 states have succeeded in passing legislation that bans surprise medical billing.