Insurance Commissioner, Legislators Again Convene Stakeholders Regarding Out of Network Billing Legislation

December 2, 2016

On November 15, the Office of the Insurance Commissioner (OIC) convened a second large stakeholder meeting regarding the intent of the Commissioner and legislators to introduce balance billing (“Surprise Billing”) legislation this session.  Attendees included Insurance Commissioner Mike Kreidler, State Representative  Eileen Cody, State Representative  Michelle Caldier, representatives of health plans and representatives of WSHA, WSMA and physician groups.  The main purpose of the meeting was to seek consensus on a methodology to determine default payment rate that plans would pay in absence of a contract.  The discussion also sought stakeholder consensus for details of a dispute/arbitration process to appeal the fallback rate.  Both a default rate and arbitration mechanism are expected to be components of the legislation.

While a number of options were discussed, there was little consensus among stakeholders regarding the methodology to determine a default payment rate in the absence of a negotiated agreement.  Some stakeholders recommended an approach based on a statistical calculation of charge amounts.  Others preferred a method based on a proportion of plan payment rates for in-network services. Stakeholders were asked to provide additional comments to the OIC by November 30, after which the sponsors of the legislation are expected to select a methodology for the legislation.  In its comment letter, WSHA advised OIC it does not support a default payment rate approach and encouraged OIC to limit the scope of the legislation to emergency services and facility based physicians such as radiology, pathology, and anesthesia. (Andrew Busz,


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