Child Health, Health Insurance, Health News

Surprise medical bill? In Washington state you’re protected now.

From the Washing State Office of the Insurance Commissioner

Have you or someone you know ever received a medical bill for something you thought was covered? Starting this year, surprise medical billing in most situations is no longer allowed.

Many of you shared your stories with us and last year, Commissioner Kreidler proposed legislation to ban this practice once and for all.

He’d tried several years before, but this time — fueled with your stories as evidence and the help of some dedicated lawmakers — he succeeded.

So what does this mean for you?

If you go to an emergency room or have a scheduled procedure at hospital or surgical facility that’s covered by your health plan, you cannot be balance- or surprise-billed by certain out-of-network providers, including:

  • Surgeons
  • Anesthesiologists
  • Pathologists
  • Radiologists
  • Labs and technicians
  • Hospitalists

This is also true if you get emergency services in Idaho or Oregon.

You’re still responsible for paying your in-network cost-sharing amount including your co-pays, and deductible, but your insurance company and the out-of-network provider need to leave you out of their dispute.

Your new rights

Insurers, providers and facilities also need to tell you, if you ask, details about their provider networks — so it’s clear to you which providers/facilities you can see.

They also need to give you this notice about your rights under the new law. (We’ve included it below).

And most importantly, if you believe you’ve been surprise-billed, we want to hear about it. File a complaint and give us the details. We can contact the provider on your behalf and if it’s a repeat offender, we may turn them over to the Department of Health for enforcement.