General News
Published November 11, 2019
For
individual and family plans and fully insured group plans. Does not apply to members
with Medicare Advantage, Medicare Supplement, BlueCard, FEP, and
OptiFlex-funded group plans.
Washington state’s new Balance Billing Prevention Act (HB 1065) takes effect on January 1, 2020.
The law is intended to protect patients from
getting surprise or balance bills when they receive:
- Emergency care at
an out-of-network hospital
- Treatment at an
in-network facility but are seen by certain out-of-network providers covered
under the Act
Patients are also protected from surprise bills
for emergency services provided in an out-of-network facility in Idaho or
Oregon.
The mandate applies only to patients on fully insured health plans offered in Washington
state. Self-funded group plans can elect to participate, but there are several requirements they must implement and guidance
from the Washington State Office of the Insurance Commissioner is still pending.
Please discuss options for your clients with your Premera account manager.
Non-contracted providers covered under the new
state law can’t bill protected members above the in-network cost sharing amount
after December 31, 2019. The legislation includes a dispute resolution process
for payments for out-of-network services, as well as various communication and
transparency requirements.
Premera Blue Cross will be communicating with
providers to help ensure clarity every step of the way.