Starting Jan. 1, 2022, Washington state law protects you from surprise or balance billing if you receive emergency care at any medical facility or when you're treated at an in-network hospital or outpatient surgical facility by an out-of-network provider.
What is surprise or balance billing
Surprise billing happens because some types of medical providers, including anesthesiologists, radiologists, pathologists, and labs may not be contracted with your health insurer even though they provide services at a hospital or facility that is in your health plan’s provider network. So, in addition to your expected out-of-pocket costs, you also get a bill for the difference between what your insurer has agreed to pay that provider and the amount the provider billed for their services.
The new Balance Billing Protection Act prevents people from getting a surprise medical bill when they receive emergency care from any hospital or if they have a scheduled procedure an in-network facility and receive care from an out-of-network provider. In this case, if an insurer and provider cannot agree on a price for the covered services, they go to arbitration and cannot bill the consumer for the amount in dispute.
What to do if you get a surprise bill
If you get a surprise medical bill for a service you had before Jan. 1, 2022, contact the provider or facility and tell them your concerns. See if you can get them to lower your bill. After Jan. 1, 2022, you cannot be surprise billed for certain services. If you get a surprise bill, contact the provider or facility and tell them you believe you've been wrongly billed. You can also file a complaint with the Washington Office of the Insurance Commisioner and they will investigate on your behalf.
The law applies to most, but not all health plans
The Balance Billing Protection Act applies to all state-regulated health plans and state and school employee benefit plans. Self-funded group health plans are not regulated by the state and must notify the WAOIC if they want to opt-in to the law and offer the protections to their enrollees.