Insurance Commissioner Plans Balance Billing Legislation

December 2, 2015

Washington State Insurance Commissioner Mike Kreidler plans to submit proposed legislation in the upcoming 2016 session to limit balance billing of patients for out-of-network emergency services when a patient receives care at a facility contracted as in-network with their health plan. This would apply in cases where the hospital is contracted with a plan, but other providers, such as emergency physicians or specialists, are not. The proposed legislation is expected to be based on legislation recently passed in New York and some other states and on model language adopted by the National Association of Insurance Commissioners. It would limit balance billing by non-contracted providers of emergency services. Patients would be responsible only for the amounts they would pay for an in-network provider. Any additional remuneration for the non-contracted providers in excess of the plan’s standard in-network payment would be determined through a mediation process between the plan and the provider.

WSHA is concerned about unintended effects of the bill on hospitals and access to emergency services and will be looking closely at the details of a proposed bill once it is released. WSHA has also asked for feedback from members in order to better assess the extent of this problem.


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