Balance billing legislation places burden on hospitals

March 19, 2017

HB 2114 (originally HB 1117) is aimed at protecting patients who use an in-network hospital or ambulatory surgery center, but then receive an additional “balance” bill from an out-of-network provider for care during their stay.

WSHA supports protections for patients in emergency situations in which they have no control over who provides their care. However, the bill as currently drafted creates significant administrative burden, cost and liability for hospitals. It places non-workable requirements on hospitals to have the patient treated by in-network providersplacing the burden of network adequacy on the hospital rather than on the plans and the Office of the Insurance Commissioner. Hospitals will be required to absorb unpaid claims for patients with out-of-network emergency room bills, and saddled with non-functional administrative burdens.
Specifically, HB 2114 bans balance billing by providers and facilities for emergency services. It also bans balance billing for non-emergency services at an in-network facility for surgical, anesthesia, pathology, radiology, laboratory or hospitalist services. Since it also bans balance billing from ERISA plans, it encourages these plans to limit their contracting with little exposure for their enrollees. The arbitration process to resolve payments for out of network bills between the hospital and providers and the plans is also cumbersome. The notification provisions for patients are extremely complex as well. Click here to read more about this bill.
In general, we believe the balance billing issue would be best addressed by making sure insurers have robust and adequate networks, so patients can easily receive care with in-network providers. Rather than taking steps to ensure this, the bill inserts hospitals into the mix for things it does not or cannot legally control.
HB 2114 will be heard before the Senate Health Care Committee, likely the week of March 27. WSHA will be presenting our strong concerns with the transparency requirements. (Andrew Busz)


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