SB 5031 & SB 5699: Balance billing

February 6, 2019

WSHA testified Monday at the Senate Committee on Health & Long Term Care regarding SB 5031 and SB 5699, which prohibits providers from balance billing patient for out-of-network services in certain circumstances. The bills provide arbitration for dispute resolution and opportunity for self-funded groups to opt-in to the balance billing protections and payment requirements.  WSHA testified that if balance billing is prohibited, there must be a clear mechanism via patient insurance cards and payment statements to identify the relevant carrier groups and self-funded groups. Further, any process with an arbitrator to determine “commercially reasonable” payment should not include Medicare payment rates, which are not applicable to the commercial market the bill seeks to address.

WSHA supports efforts to protect patients from unforeseeable, unexpected billings but a bill must provide accountability to payors as well as providers.  WSHA will seek to amend SB 5031, the Insurance Commissioner’s bill to include these changes. WSHA supports SB 5699, which includes more of the provisions we are hoping to see in a final compromise. (Andrew Busz,


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