This week, two House committees passed legislation that would prohibit balance billing patients for emergency services or care the patient reasonably could have expected to be in-network. However, the bills offer differing approaches for resolving payment disputes. WSHA has strongly advocated a reasonable approach that mirrors our state’s surprise billing law.
A Ways and Means Committee bill, endorsed by WSHA, would give health plans and out-of-network providers 30 days to determine reimbursement levels for services provided in an in-network facility. If no agreement is reached, either side could use a mediated dispute resolution process to resolve the dispute. Washington Rep. Suzan DelBene co-sponsored the bill, which passed the committee unanimously.
The House Education and Labor Committee approved a bill to reimburse out-of-network providers the median in-network rate for a service in a geographic area. The legislation allows a limited independent dispute resolution process to resolve payment disputes. Washington Rep. Kim Schrier led an effort to strike the rate-setting provision. We are concerned rate-setting approaches provide no incentive for insurers to develop adequate provider networks and would come at the expense of providers, especially rural, children’s and teaching hospitals.
Four committees have passed surprise billing measures. They will now try to agree on a compromise measure to take to the House and Senate floors. Lawmakers would like to include a surprise billing measure in must-pass health legislation due before May 22. (Andrew Busz)